Get Unitedhealthcare Single Claim Reconsideration/corrected Claim Request Form 2012
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How to fill out the UnitedHealthCare Single Claim Reconsideration/Corrected Claim Request Form online
Filling out the UnitedHealthCare Single Claim Reconsideration/Corrected Claim Request Form online can be a straightforward process when approached step by step. This guide will lead you through each section of the form to ensure that all necessary information is accurately provided, facilitating a smoother reconsideration request.
Follow the steps to correctly complete the form.
- Press the ‘Get Form’ button to retrieve the form and open it in your preferred document editor.
- Begin by providing the member information, including the member ID, date the form was completed, control or claim number, date of service, and the billed amount. Ensure that the member's last name, first name, middle initial, street address, state, and zip code are accurately filled out.
- Next, enter the patient’s information by including their last name, first name, and middle initial as required.
- Proceed to fill in the physician or health care professional information, providing the tax identification number (TIN), phone number, and the name of the physician or health care professional exactly as listed on the Provider Remittance Advice (PRA) or Explanation of Benefits (EOB). Include the corresponding street address, state, and zip code, as well as the facility or group name and contact person.
- Indicate the option amount owed by the claim, and select the reason for request from the provided options. Detailed explanations for each option are located on the Claim Reconsideration definition sheet, which can be found online.
- In the comments section, clearly state what you are seeking from UnitedHealthcare to resolve the claim, including the dollar amount, if applicable.
- Attach all required documents, including a copy of the PRA or EOB. A claim form is only necessary for corrected claim submissions, along with any additional required attachments listed.
- Once all sections are completed and verified for accuracy, save your changes to the document. You can then download, print, or share the form as necessary to submit your claim reconsideration request.
Start filling out your UnitedHealthCare claim reconsideration form online today for a seamless process.
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UnitedHealthcare typically processes reconsiderations within 30 days of receiving the completed UnitedHealthCare Single Claim Reconsideration/Corrected Claim Request Form. However, the actual time may vary depending on the complexity of the claim and the specific circumstances surrounding the request. It's advisable to keep track of your submission and reach out if you do not hear back within the expected timeframe. Staying informed helps you manage your claim process smoothly.
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