Claims submissions and disputes

If a provider does not agree with the outcome of a claim determination, the provider may challenge the decision by using the claim payment appeals process. If there is a full or partial claim rejection or the payment is not the amount expected, submit a claims appeal. The appeal must be received by UniCare Health Plan of West Virginia, Inc. (UniCare) within 180 days from the date on the notice of the letter advising of the action.

UniCare uses Availity*, a secure, full-service web portal that offers a claims clearinghouse and real-time transactions at no charge to health care professionals. Use Availity to submit claims, check the status of claims, appeal a claim decision and much more .

Don’t have an Availity account?

* Availity, LLC is an independent company providing administrative support services on behalf of UniCare Health Plan of West Virginia, Inc.

Finding claims tools on Availity

Submit claims

  1. From the Availity home page, choose Claims & Payments from the top navigation.
  2. Select Type of claim from the drop-down menu.

Claims status inquiry

  1. From the Availity home page, select Claims & Payments from the top navigation.
  2. Select Claim Status Inquiry from the drop-down menu.

Claims dispute

To check claims status or dispute a claim:

  1. From the Availity home page, select Claims & Payments from the top navigation.
  2. Select Claim Status Inquiry from the drop-down menu.
  3. Submit an inquiry and review the Claims Status Detail page.
  4. If the claim is denied or final, there will be an option to dispute the claim. Select Dispute the Claim to begin the process. You’ll be redirected to the payer site to complete the submission.

Clear Claims Connection

To use Clear Claims Connection:

  1. From the Availity home page, select Payer Spaces from the top navigation.
  2. Select the health plan.
  3. From the Payer Spaces home page, select the Applications tab.
  4. Select the Clear Claims Connection tile.

Related information

Provider tools & resources

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