Get United Healthcare Physician Verification Form

This guide will help you navigate and complete the United HealthCare Physician Verification Form efficiently. Whether you are verifying a patient's chronic condition or assisting an applicant, these step-by-step instructions will ensure the process is straightforward.

Follow the steps to complete the physician verification process.

1. Click the ‘Get Form’ button to access the form and open it in your preferred document editor.
2. Begin by entering the applicant's name and address in the designated fields. Make sure to provide accurate and complete information.
3. Fill in the applicant's Medicare ID number in the specified field. This information is crucial for verifying their eligibility.
4. Input the applicant's date of birth accurately. This helps to confirm their identity and eligibility for the plan.
5. Check the relevant chronic condition(s) by marking the appropriate boxes provided on the form. If the patient does not have any of the listed conditions, indicate this in the specified box.
6. Complete the required information for the physician's clinic, including the clinic's name, Tax ID, phone number, and fax number.
7. Enter the physician's name and the name of the staff member verifying the illness diagnosis, along with the date of verification.
8. Finally, review all filled information for accuracy. Once confirmed, save your changes and proceed to fax the completed form to the Evercare Verification Unit at 1-501-262-7070. You can also call them at 1-877-685-2385 for verification over the phone.

Get started with the form online and ensure timely verification for your patient's enrollment.