UHC Request For Reconsideration Form - Cat Health Benefits 2025

1. Click ‘Get Form’ to open the UHC Request For Reconsideration Form in our editor.
2. Begin by filling out the 'Enrollee Information' section. Indicate whether you are a Commercial, Medicare, or Medicaid enrollee and provide your Enrollee ID and name.
3. Next, complete the 'Patient Name' field with the patient's last name, first name, and middle initial. Also, fill in the Control/Claim number, Date of Service (D.O.S.), and Billed Amount.
4. In the 'Physician/Health Care Professional Information' section, enter the Tax Identification Number and the physician's name as listed on the Provider Remittance Advice (PRA) or Explanation of Benefits (EOB).
5. Select a reason for reconsideration from the provided options and include any necessary explanations or comments in the designated area.
6. Attach required documents such as a copy of PRA or EOB directly within our platform for easy submission.

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