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Get UMR AD1113 2015-2022

Atient name 3) Itemized charges 4) Date of service 5) Type of service Cancelled checks, non-itemized receipts and balance due bills are NOT ACCEPTABLE proof of expenses You can file claims online or fax completed claim form & supporting documentation toll free to 877-390-4782. You can also mail the completed form & supporting documentation to: UMR / PO Box 8022 / Wausau WI 54402-8022. If you have questions, please call: 800-826-9781, or contact us online at www.umr.com B. EMPLOYEE INFORMATION E.

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