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Claim Reconsideration Request Form (Non-Clinical 2025

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The document is a Claim Reconsideration Request Form that outlines the process for providers to submit requests for reconsideration of denied claims. It includes instructions for submission, required information about the provider and member, details on claim types, and reasons for denial. The form emphasizes the need for complete documentation and provides guidance on handling multiple claims.

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Versions	Form popularity	Fillable & printable
2019	4.2 Satisfied (34 Votes)
2015	4 Satisfied (60 Votes)

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How to submit an appeal with UnitedHealthcare?

Mail or Fax. Write a letter describing your appeal or use the Redetermination Request Form (PDF) (67.62 KB). Mail or fax the letter or completed form to UnitedHealthcare.

What is the UnitedHealthcare fax number?

Please complete this entire form and fax it to: 866-940-7328.

What is the fax number for the United Healthcare reconsideration form?

Your doctor or provider can contact UnitedHealthcare at 1-800-711-4555 for the Prior Authorization department to submit a request, or fax toll-free to1-844-403-1028 call at 1-866-842-4968 (TTY 711), 8 a.m. 8 p.m. local time, 7 days a week.

Where do I send my UHC reconsideration form?

Where do I send my United Healthcare reconsideration form? Send the letter or the Redetermination Request Form to the Medicare Part C and Part D Appeals and Grievance Department PO Box 6103, MS CA124-0197, Cypress CA 90630-0023.

What is a medical reconsideration?

APPEALS AND RECONSIDERATIONS (MEDICAL) APPEALS (NON-PARTICIPATING PROVIDERS AND MEMBERS) Procedures that deal with the review of adverse initial determinations made by the plan on health care services or benefits under Part C or D the enrollee believes they are entitled to receive.

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Can I fax claims to UnitedHealthcare?

Go to Claim Information for a list of addresses of where you can mail paper claims. ► Can I fax a claim? We accept claims by fax at 248-733-6372, apart from those indicated below.

Claim Reconsideration Request Form (Non-Clinical 2025

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How to change Claim Reconsideration Request Form (Non-Clinical online

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Got questions?

How to submit an appeal with UnitedHealthcare?

What is the UnitedHealthcare fax number?

What is the fax number for the United Healthcare reconsideration form?

Where do I send my UHC reconsideration form?

What is a medical reconsideration?

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Can I fax claims to UnitedHealthcare?

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