We use cookies to improve security, personalize the user experience, enhance our marketing activities (including cooperating with our marketing partners) and for other business use.
Click "here" to read our Cookie Policy. By clicking "Accept" you agree to the use of cookies. Read less
Read more
Accept
Loading
Form preview
  • US Legal Forms
  • Form Library
  • Industry Forms
  • Industry Insurance & Medical Forms
  • Unitedhealthcare Single Claim Reconsideration/corrected Claim Request Form 2012

Get Unitedhealthcare Single Claim Reconsideration/corrected Claim Request Form 2012

UnitedHealthcare Claim Reconsideration Request Form Instructions: This form is to be completed by UnitedHealthcare contracted physicians, hospitals or other health care professionals to request a.

How it works

  1. Open form

    Open form follow the instructions

  2. Easily sign form

    Easily sign the form with your finger

  3. Share form

    Send filled & signed form or save

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.

  1. Press the ‘Get Form’ button to retrieve the form and open it in your preferred document editor.
  2. 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.
  3. Next, enter the patient’s information by including their last name, first name, and middle initial as required.
  4. 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.
  5. 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.
  6. In the comments section, clearly state what you are seeking from UnitedHealthcare to resolve the claim, including the dollar amount, if applicable.
  7. 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.
  8. 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.

Get form

Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.

Related content

Claim Reconsiderations, Appeals and Grievances
Creating a new claim. If a claim was denied and you resubmit the claim (as if it were a...
Learn more
UNITEDHEALTHCARE INSURANCE COMPANY
Aug 1, 2024 — The written request for an. Expedited Internal Appeal should be sent to:...
Learn more
Invitae Corporation
... claims that involve more than One hundred Thousand dollars. ($100,000.00) individually...
Learn more

Related links form

Navfac 11240 10 QUALIFIED SUPPLIER'S LIST APPLICATION DSCP FORM 1696 G, NAVMC 11754 - CO/PSR OIC's AR Application Screening/Interview ... RECP Application Form NAVMC 11505 (10-04) - Naval Forms Online

Questions & Answers

Get answers to your most pressing questions about US Legal Forms API.

Contact support

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.

To submit an appeal to UHC, begin with the UnitedHealthCare Single Claim Reconsideration/Corrected Claim Request Form. Clearly articulate the reason for your appeal in the provided space and attach supporting documentation that reinforces your case. Once completed, send the appeal through the recommended UHC submission channels to ensure it is properly addressed.

Submitting a corrected claim to UnitedHealthcare involves using the UnitedHealthCare Single Claim Reconsideration/Corrected Claim Request Form. Fill out the form with accurate information and make sure to indicate that this is a corrected claim. After completing the form, send it through the designated channels for UHC claims, ensuring you include all relevant details to avoid processing delays.

To submit a reconsideration request, you will need the UnitedHealthCare Single Claim Reconsideration/Corrected Claim Request Form. Begin by filling out the form with accurate details regarding your claim. Then, send the completed form to the appropriate UnitedHealthcare address, ensuring that you include any necessary supporting documents that may strengthen your case.

A claim reconsideration is the action of reviewing a denied claim to assess whether it can be approved upon resubmission of further evidence. This process allows healthcare providers or members to correct misunderstandings or supply missing information. The UnitedHealthCare Single Claim Reconsideration/Corrected Claim Request Form helps streamline this process by presenting the case efficiently.

An example of reconsideration might be a case where a claim for a medical service was initially denied due to insufficient information. If additional documents, like test results or detailed notes from the healthcare provider, are gathered later, you can request reconsideration of the claim. By using the UnitedHealthCare Single Claim Reconsideration/Corrected Claim Request Form, you can ensure that all new information is submitted in an organized manner.

A good reason for reconsideration typically involves new documentation or evidence that changes the context of the original claim. For instance, if there was a coding error or missing clinical information that could affect the claim’s outcome, it may warrant reconsideration. The UnitedHealthCare Single Claim Reconsideration/Corrected Claim Request Form can help you present these newly discovered details clearly.

While a claim for reconsideration and an appeal both address denied claims, they are not the same. Claims reconsideration involves re-evaluating the initial claim with additional information, whereas an appeal typically follows a more formal process that may require a written request. You can utilize the UnitedHealthCare Single Claim Reconsideration/Corrected Claim Request Form to streamline your reconsideration process.

Claims reconsideration is the process by which a healthcare provider or member asks for a review of a previously denied claim. This process allows you to present additional information or clarify the reasoning behind the claim. Using the UnitedHealthCare Single Claim Reconsideration/Corrected Claim Request Form can facilitate this review process, ensuring that all relevant details are considered.

Submitting a reconsideration on UnitedHealthcare involves filling out the UnitedHealthCare Single Claim Reconsideration/Corrected Claim Request Form accurately. Ensure you provide detailed information regarding the initial claim and the reasons for the reconsideration. This form can be submitted online or through mail, and doing so promptly can help expedite the review process. Consider using our platform for guidance on searching for any specific forms.

Get This Form Now!

Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.
If you believe that this page should be taken down, please follow our DMCA take down processhere.

Industry-leading security and compliance

US Legal Forms protects your data by complying with industry-specific security standards.
  • In businnes since 1997
    25+ years providing professional legal documents.
  • Accredited business
    Guarantees that a business meets BBB accreditation standards in the US and Canada.
  • Secured by Braintree
    Validated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.
Get UnitedHealthCare Single Claim Reconsideration/Corrected Claim Request Form
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
UnitedHealthCare Single Claim Reconsideration/Corrected Claim Request Form
This form is available in several versions.
Select the version you need from the drop-down list below.
2019 UnitedHealthCare Single Claim Reconsideration/Corrected Claim Request Form
Select form
  • 2019 UnitedHealthCare Single Claim Reconsideration/Corrected Claim Request Form
  • 2012 UnitedHealthCare Single Claim Reconsideration/Corrected Claim Request Form
Select form