Coverage profile
Work UnitedHealthcare Community Plan across every published route
Use the current payer record to choose the right claim-status, eligibility, portal, phone, or appeals workflow. Substrate only marks routes that are published for this payer.
Claim status
EDI 276/277The Substrate Claim Status Agent can check clearinghouse claim status for your practice with UnitedHealthcare Community Plan.
Eligibility
EDI 270/271The Substrate Eligibility Agent can verify patient benefits, identify TPAs and carve-outs, and more with UnitedHealthcare Community Plan.
Other aliases
Also known as
- 04567
- 6893
- 86048
- UHC Community Plan
Payer intelligence
Observed adjudication timing
How long completed claims in Substrate’s aggregate network took from payer receipt to the 835 payment date.
Median time to payment
13 days- 10% of adjudications by
- 8 days
- 90% of adjudications by
- 14 days
- Applicable state coverage
- NY
- Current As Of
- July 2026
Five-month median trend
Days to 835 paymentView chart data as a table
| Service month | Median | 10% of adjudications by | 90% of adjudications by | Completed claims | Coverage |
|---|---|---|---|---|---|
| Apr | 11 days | 7 days | 69 days | 225 | NY |
| May | 13 days | 9 days | 16 days | 476 | NY |
| Jun | 13 days | 7 days | 14 days | 393 | NY |
| Jul | 13 days | 8 days | 14 days | 414 | NY |
| Aug | No qualified data | ||||
2027 maternity billing research
When does UnitedHealthcare Community Plan change OB/GYN billing?
If CMS finalizes the proposed 2027 maternity HCPCS G-codes, UnitedHealthcare Community Plan says providers should report maternity services with those G-codes. If not, dates of service on or after January 1, 2027 move from global obstetric reporting to phase-based reporting. Services on or before December 31, 2026 are reported under CPT 2026, including 59425, 59426, or E/M, and services on or after January 1, 2027 use the appropriate E/M code. Antepartum-only global codes no longer apply in 2027. UnitedHealthcare may revise this after the final CMS rule.
- Transition start
- 2027-01-01, contingent on whether CMS finalizes the proposed G-codes
- Billing start
- 2027-01-01 — contingent reporting change
- Published
- 2026-10-01
- Current As Of
- October 2026
Scope: UnitedHealthcare Community Plan Medicaid professional claims. The bulletin states all states. It does not apply to Medicare Advantage or AARP products, and it is separate from the unitedhealthcare record.
UnitedHealthcare Community Plan Reimbursement Policy Update Bulletin: October 2026 (Obstetrical Policy, Professional). Verify the payer source before claim submission.
Frequently asked questions
UnitedHealthcare Community Plan payer FAQs
How do I check claim status with UnitedHealthcare Community Plan?
Providers check UnitedHealthcare Community Plan via EDI 276/277 when the payer ID is accepted. Substrate automates claim status across 3,500+ payers.
What is the payer ID for UnitedHealthcare Community Plan?
The primary payer ID for UnitedHealthcare Community Plan is 04567. The correct routing ID can differ by clearinghouse and transaction, so compare the 837P, 837I, 835, 270, and 276 entries before submitting.
What are the 837 payer IDs for UnitedHealthcare Community Plan?
The 837P and 837I payer ID for UnitedHealthcare Community Plan is 04567 via Stedi.
What is the 835 payer ID for UnitedHealthcare Community Plan?
The 835 payer ID for UnitedHealthcare Community Plan is 04567 via Stedi.
What is the 270 payer ID for UnitedHealthcare Community Plan?
The 270 payer ID for UnitedHealthcare Community Plan is 04567 via Stedi.
Routing reference
UnitedHealthcare Community Plan payer IDs and operating states
Use the payer ID listed for the transaction you are submitting. Verify current routing and enrollment requirements with your clearinghouse.
| Payer name | UnitedHealthcare Community PlanSource: Substrate payer directory · data last changed |
|---|---|
| 837P professional claims payer IDStedi | 04567Source: Stedi payer catalog · catalog dated · matched by payer ID |
| 837I institutional claims payer IDStedi | 04567Source: Stedi payer catalog · catalog dated · matched by payer ID |
| 835 ERA payer IDStedi | 04567Enrollment requiredSource: Stedi payer catalog · catalog dated · matched by payer ID |
| 270 eligibility payer IDStedi | 04567Source: Stedi payer catalog · catalog dated · matched by payer ID |
Routing sources and verification
- Substrate payer directoryPayer identity, aliases, operating states, and vendor IDs. Data last changed ; checked .Open payer website ↗
- Stedi payer catalogMatched by payer ID; matched record: UnitedHealthcare Community Plan. Source dated .PrimaryPayerId is used as the transaction payer ID when the corresponding Stedi support flag is true.Open current Stedi reference ↗
Clearinghouse payer IDs are transaction-specific and can change. Confirm the current payer list and the member’s ID card before submission.