Admission notification required to avoid reduced reimbursement

Help ensure your facility is fully reimbursed by taking the necessary steps for member admission and following the required notification timeline

Beginning Sept. 1, 2025, we will enhance enforcement of our policy to reduce your reimbursement amount if we receive the admission notification late or not at all. Note: We do not apply reductions for maternity admissions. We apply reductions for post-acute inpatient admissions on our commercial plans, but we do not apply them on our MA plans.

You may not balance bill the member for the reimbursement reduction. The amount reduced depends on the following:

Admission notification timeline	Reimbursement reduction
Between 24 and 72 hours of admission	100% of the average daily contract rate* for the days preceding notification
After 72 hours of admission	100% of the contract rate (entire stay)
No admission notification received	100% of the contract rate (entire stay)

* The average daily contract rate is calculated by dividing the contract rate for the entire stay by the number of days for the entire length of stay.

What this means for your facility

According to your UnitedHealthcare Participate Agreement, you’re required to notify us within a specific timeline when a member is admitted into your facility:**

Time of admission	Standard notification requirements
Weekdays	Within 24 hours
Weekends and holidays	By 5 p.m. local time on the next business day
Emergencies	Within 24 hours, or the next business day if on a weekend/holiday, from the time coverage information is known

** Exact requirements could vary for some facilities based on non-standard provider contract language or a state specific regulation.

The timely admission notification requirement applies to our commercial, Individual Exchange plans, also referred to as UnitedHealthcare Individual & Family ACA Marketplace, and Medicare® Advantage plans.

How to avoid reimbursement penalties

Take these steps to help ensure your facility is fully reimbursed for a member’s stay:

Verify member eligibility and benefits before admission
Complete the admission notification with all required information
Electronically notify us of the member’s admission within the required timeline

Admission notification does not ensure payment. Payment for covered services depends on the member’s benefits, facility’s contract, claim processing requirements and eligibility for payment.

How to verify member eligibility and benefits

You can verify member eligibility and determine member benefits through the UnitedHealthcare Provider Portal:

Go to UHCprovider.com and click Sign In at the top-right corner
Enter your One Healthcare ID and password
- New users who don’t have a One Healthcare ID: Visit UHCprovider.com/access to get started
Select Eligibility and enter your search criteria

For detailed instructions, go to our Eligibility and Benefits interactive guide.

How to send notifications

You must send admission notifications electronically using one of the methods below. We will not accept them by phone or fax, except in states where required by law.

UnitedHealthcare Provider Portal
You can access the Prior Authorization and Notification tool through the UnitedHealthcare Provider Portal:
- Go to UHCprovider.com and click Sign In at the top-right corner
- Enter your One Healthcare ID and password
  - New users who don’t have a One Healthcare ID: Visit UHCprovider.com/access to get started
- In the menu, select Prior Authorizations
  For detailed instructions, go to the admission notification section of our Prior Authorization and Notification interactive guide.
Electronic funds transfer (EFT)
Use EFT transaction 278N to notify us of facility admissions