UnitedHealthcare
Largest commercial payer by expected net revenue. Yield below target with recurring down-code patterns and slow adjudication — the largest recoverable exception pool. In annual renewal window.
Contract
Fictional demo contractContract
Fictional demo contractExtracted terms
Verified- Pay per Attachment 1 fee schedule (Attachment 1 · Per claim)Breached
- Adjudicate clean claims within 21 days (§5.2 · Per claim)At risk
- Resolve disputes within 30 days (§6.1 · As filed)At risk
- 2025-01-01 — Annual fee-schedule update+2.1% blended
Vendor profile
- cheryl.ford@trh.example.org
- Phone
- (555) 0111
- Owner
- C. Ford, Managed Care Director
Fictional TRH-side owner — example address, 555 number. No public payer contacts are used.
Offers health benefit plans nationwide and works with more than 7,000 hospitals and care facilities to help make the health system work better for members. source
- HQ
- 9700 Health Care Lane, Minnetonka, MN 55343 (per U.S. HHS TAGGS record; not stated on uhc.com pages fetched) ↗
- Website
- www.uhc.com/about-us
- Reference
- About UHC & our mission ↗
Public background only. No TRH relationship, contract, or endorsement with this company is real.
Performance
Below target6-month trend. Period is chosen to suit this relationship's category.
Weighted scorecard
Weighted: 72Transparent weights (editable in the roadmap build). Each criterion shows target, actual, score, trend, source, and open exceptions.
Exceptions & evidence
4 openDown-code pattern on outpatient E/M claims below fee schedule.
Elevated no-authorization denials vs. contract policy.
Implant carve-out not applied on two surgical claims.
Clean-claim adjudication exceeding 21-day contract window.
Corrective actions
Archive-don't-delete: resolved items move to an archived status with their evidence intact — nothing is destroyed.