Carrier News

UHC Information about Eligibility Verification Audits

UnitedHealthcare routinely audits the eligibility of a random selection of existing customers in conjunction with each group’s renewal each year. See their Eligibility Verification resource page for more information. UHC sends the following correspondence to groups selected for audit. The notification letter includes the forms UHC requires the client to complete.

  1. 90 days prior to renewal, notice sent to client and broker. See sample letter.
  2. 60 days prior to renewal, notice sent to client and broker if no response to prior request
  3. 30 days prior to renewal, notice sent to client and broker if no response to prior requests
  4. 2 weeks prior to renewal, if no response to prior requests, Certificates of Credible Coverage sent to all members showing an end date for their current policy.

UHC will terminate a group’s coverage if they do not respond to the audit, provide incomplete information, or do not meet the eligibility requirements defined in the contract. Once all information is provided, UHC may take up to five business days to process information. If a group policy terminates, the group will have a 15-day grace period after the termination date to submit their documentation for reinstatement. UHC cannot process a renewal, any plan changes, or membership changes until the audit is approved. No exceptions. Groups that wait until the last week run the risk of being terminated if the audit is not fully approved prior to the renewal date.

Groups receiving an Eligibility Verification Audit should do the following:

  • Complete the Employer Information Form contained in the notice letter (or this form if lost)
  • Provide supporting tax documentation requested, which may include the Texas C-3 Worksheet (employer’s quarterly report), Quarterly TWC Report[s], Forms 1065/1120S Schedule K-1, etc.
  • Using the status codes provided on the Employer Information Form, indicate the status of each employee listed on the tax documentation. The first five digits of social security numbers may be blacked out.
  • Complete all other forms included in the audit request
  • Return the documentation by mail, fax, or email.
Fax 877-232-7902
Phone 877-504-1179
Mail UnitedHealthcare Risk Management
9700 Health Care Lane
Minnetonka, MN 55343

For more information or to check the status of the verification audit, visit their resource page:

This entry was posted in Carrier News and tagged , , , , , . Bookmark the permalink. Follow any comments here with the RSS feed for this post. Both comments and trackbacks are currently closed.