Alyssa Lane
UMR, a subsidiary of UnitedHealthcare, is a third-party administrator (TPA) that works with group health plans to help administer healthcare benefits for their members. With over 70 years of experience, UMR serves more than 3,800 benefit plans and their 6 million members. The company aims to provide flexible, innovative solutions to healthcare challenges, pairing personalized service with intuitive technology to build stronger connections and achieve meaningful results. UMR's goal is to simplify the complex aspects of healthcare, ensuring that customers have access to the answers and resources they need.
| Characteristics | Values |
|---|---|
| Position | UMR is a third-party administrator and a subsidiary of UnitedHealthcare, a UnitedHealth Group company. |
| Members | UMR serves over 6 million members. |
| Benefits Plans | UMR serves over 3,800 benefits plans. |
| Services | UMR provides customer service teams, processes claims, coordinates care, and provides educational resources. |
| Goals | UMR aims to simplify healthcare, provide personalized service, and improve the health system. |
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What You'll Learn
UMR's role as a third-party administrator
UMR, a subsidiary and third-party administrator for United Healthcare Services Incorporated, is a medical insurance provider. It is the nation's largest third-party administrator (TPA), serving over 3,800 benefits plans and their 6 million members.
As a TPA, UMR helps administer health care benefits for members of group health plans. It processes claims for services from healthcare providers and has medical professionals on staff to coordinate care for members facing serious health issues or hospitalisation.
UMR provides prompt, personalised service to its members. Each member has access to a customer service team that can assist with questions about their health benefits. Members can also receive an Explanation of Benefits (EOB) for health claims submitted by their healthcare providers.
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Group health plans
UMR offers a secure provider portal on its website, which includes a Prior Authorization Requirement Search and Submission Tool. This tool enables providers to look up services for specific members and determine if prior authorization or pre-determination is required. The integrated tool allows for a streamlined process, as providers can submit requests for review directly through the portal. This feature is applicable to most UMR-administered group health care plans.
For providers treating patients under specific plans, such as the Associates' Health and Welfare Plan or Sierra Health-Care Options (SHO) health care plans, UMR provides a straightforward process for prior authorization. This includes the option to upload supporting documentation with a provided passcode.
UMR's group health plans provide a comprehensive approach to healthcare coverage, giving employers and employees access to necessary tools and resources. The plans aim to simplify the process of managing healthcare, prior authorization, and related administrative tasks.
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Customer service
UMR is a third-party administrator that manages group health plans. They process claims for services from healthcare providers and have medical professionals on staff to help coordinate care for members.
As a plan member, you have access to a customer service team that can assist you with any questions or concerns you may have about your health benefits. This team is made up of helpful people who can provide prompt and personalized service. They can also help you understand any explanation of benefits (EOB) documents you may receive for health claims submitted by your healthcare providers.
UMR typically processes claims within 30 days of receiving them from providers. During this time, they may contact you to request additional information to complete your claim. You can also check the status of your claims by visiting the UMR website or using the UMR app and selecting the claims tab.
New members can create a HealthSafe ID by visiting the UMR website or downloading the UMR app. A HealthSafe ID provides a secure way to log in to your accounts and quickly and easily access your information.
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Explanation of benefits
An Explanation of Benefits (EOB) is a document that outlines the costs associated with your medical care and what will be covered by your insurance plan. It is not a bill, but it will explain any charges that you still owe or may have already paid, such as a copay. An EOB will also detail any discounts you received by accessing care or medical products within your plan's network of providers.
The EOB will also outline any amounts paid from spending accounts, such as a health reimbursement account (HRA), and any outstanding amounts you are responsible for paying. It is important to note that if you owe additional money after the insurance company has paid its portion, you will receive a separate bill from the medical provider, which should match the patient's portion listed on the EOB.
The EOB is a standard document among insurance companies and typically includes a glossary of terms and definitions, as well as instructions on how to appeal a claim if necessary. It provides specific details about the cost of the care you received and may also reflect what portion of your out-of-pocket medical expenses count toward your annual deductible.
As a general rule, for services that are not covered by a copay, you should wait to pay the medical provider until you receive an EOB from your health plan. If there are any discrepancies between the EOB and the bill you received, you should contact both the provider and your health plan to clarify the amount you owe.
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Online member services
UMR is not an insurance company; instead, your employer pays the portion of your health care costs not paid by you. UMR is a UnitedHealthcare company that offers online member services through its website and mobile app.
The UMR app provides members with on-demand, anytime, anywhere access to their health care benefits information. Members can access their proof of coverage online or through the UMR app. This allows members to stay connected and access their healthcare information on the go.
The UMR online services portal provides detailed information about the procedures and protocols followed by the company to ensure member privacy. The website also offers assistance to members who need help using the website or downloading PDFs.
To access the online member services, members can visit the UMR website or download the UMR app on their mobile devices. The online portal and app provide a convenient way for members to stay connected to their healthcare benefits and access their coverage information at their convenience.
UMR is committed to protecting the privacy of its members and has strict procedures and protocols in place to ensure that member information is kept secure. Members can review the privacy policies and procedures on the UMR website to understand how their information is protected.
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Frequently asked questions
UMR is a third-party administrator (TPA) that is a part of UnitedHealthcare, a diversified health and well-being company under UnitedHealth Group.
UMR helps administer health care benefits for members with group health plans. They process claims for services from health care providers and help coordinate care for members with serious health conditions or hospitalisations.
UMR aims to simplify the complicated parts of healthcare for its customers and members. They strive to provide flexible and innovative solutions to healthcare challenges, making healthcare simple, seamless, and affordable.
