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Get Optum Provider Express

Is form is to be completed by United Behavioral Health contracted clinicians or hospitals to request a claim adjustment for a United Behavioral Health (including PacifiCare Behavioral Health) member. There are two stages available: 1) Claim Inquiry/Adjustment Request and 2) Formal Provider Dispute* (See attached description) UBH Contracted Individual Clinician UBH Contracted HOSPITAL UBH Contracted Group First Submission (Claim Inquiry/Adjustment Request) I understand by checking First.

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