Get United Healthcare Reconsideration Form

Filling out the United Healthcare Reconsideration Form online is an essential step for healthcare professionals seeking to address claims for services rendered to enrollees. This guide will walk you through each section of the form, ensuring a smooth and accurate submission process.

Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to access the United Healthcare Reconsideration Form and open it in your preferred editor.
2. In the 'Date' field, enter the current date of your submission to ensure timely processing.
3. Select the type of provider submitting the appeal by checking the appropriate box for 'Physician,' 'Hospital,' or 'Other health care professional.'
4. In the 'Enrollee Information' section, fill in the enrollee’s name, date of birth, control or claim number, date of service, and billed amount for reference.
5. Provide your Tax Identification Number in the 'Physician/Health Care Professional Information' field, along with your name, contact person, and phone number for follow-up.
6. Select the reason for your request from the provided options, ensuring to attach any necessary supporting documentation as required.
7. In the 'Comments' section, provide any additional explanations or clarifications related to your appeal if needed.
8. Ensure that you attach all required documents, including the Provider Remittance Advice (PRA), claim form, medical documentation, and any other supporting materials.
9. Review all entries for accuracy and completeness to avoid delays, then proceed to save the changes, download the completed form, print it, or share it as necessary.

Complete the United Healthcare Reconsideration Form online today for an efficient resolution of your appeal.