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Provides guidance to submit a reconsideration request through the UnitedHealthcare Provider Portal, including how to locate the claim and choose available actions, complete required fields, attach supporting documents, and submit. Includes instructions for submitting the paper form when electronic submission is not possible, clarifying it is for one claim per form, not for bulk claims, and not for formal appeals or disputes. 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Complete the fields, attach supporting documents, and submit.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"Can the paper form be used for multiple claims or bulk submission?",{"text":113,"@type":109},"No. The paper form is for submitting one claim at a time and should not be used for bulk or multiple claims. Submit a separate form for each claim.",{"name":115,"@type":106,"acceptedAnswer":116},"What does the form require for the reconsideration reason and attachments?",{"text":117,"@type":109},"Select a reason for the request from the listed options and include comments when applicable. Attach required documents such as a copy of the PRA or EOB as support for the request.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},278990,1790480110,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":35,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":73,"language":135,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":61,"update_tm":139,"read_time":9},2336475104042,"https://ap-avatar.wpscdn.com/avatar/22000c4c32af1715be0?x-image-process=image/resize,m_fixed,w_180,h_180&k=1786537525561427321","Claim reconsideration form  \nIf you disagree with a claim reimbursement decision, you can challenge it by providing comments, documents or other information to explain why you think the decision should be changed.  \nYou can submit a claim reconsideration request through the UnitedHealthcare Provider Portal:  \n• Go to [UHCprovider.com](UHCprovider.com) and click Sign In at the top-right corner  \n• In the menu, select Claims & Payments > Look up a Claim and enter your search criteria  \n• Find your claim and click on the claim number to see details  \n• Scroll down to the Act on a Claim section and select Explore available actions. Select claim lines > click Next > select Create a reconsideration (if available) > click Next  \n• Complete the fields, attach supporting documents and submit For step-by-step training, visit our Claims interactive guide.  \nIf electronic submission isn’t possible, use the following form. This form is for submitting 1 claim at a time, not for bulk or multiple claims.  \nNotes:  \n• Please submit a separate form for each claim  \n• Do not submit new claims with this form  \n• Do not use this form for formal appeals or disputes. Continue to use your standard process.  \nQuestions?  \nFor chat options and contact information, visit Contact us  \n| Member information |  |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- |\n| Date form completed: |  | Member ID: |  |  |  |  |\n| Control/Claim \\# |  |  | Date of service: |  | Billed amount: |  |\n| Member last name: | First name: |  |  |  |  | Middle initial: |\n| Street address: |  |  |  | State: |  | ZIP code: |\n| Patient last name: | First name: |  |  |  |  | Middle initial: |\n\nPhysician/health care professional information  \n\n| Tax ID number (TIN): | Phone number (with area code): |\n| --- | --- |\n\nEmail:  \nPCA-1-25-00612-POE-FM_03312025  \n| Physician/health care professional information (cont.) |  |  |\n| --- | --- | --- |\n| Physician or other health care professional name as listed on provider remittance advice (PRA)/explanation of benefits (EOB) |  |  |\n| Last name: | First name: | Middle initial: |\n\nStreet address:  \n\n| City: | State: | ZIP code: |\n| --- | --- | --- |\n| Facility/group name: | Contact person: |  |\n| Expected amount owed: | Contact fax number (with area code): |  |\n\nReason for request  \n\n| 1. Previously denied or closed as Exceeds Filing Time |\n| --- |\n| 2. Previously denied or closed for Additional Information |\n| 3. Previously denied or closed for Coordination of Benefits information |\n| 4. Resubmission of a claim that has been corrected |\n| 5. Previously processed, but rate applied incorrectly resulting in overpayment/underpayment (network providers, check your fee schedules) |\n| 6. Resubmission of Prior Notification Information |\n| 7. Resubmission of a claim with Bundled services |\n| 8. Other (explain in Comments) |\n| Comments: |\n| Required attachments |\n\n• Copy of PRA or EOB  \nYou may have additional rights under individual state laws. Please review your provider administrative guide or your provider agreement/contract if you need more information.  \nAfter completing the entire form, please mail to UnitedHealthcare using the address listed on the PRA.  \nInsurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates. Health plan coverage provided by UnitedHealthcare of Arizona, Inc., UHC of California DBA UnitedHealthcare of California, UnitedHealthcare Benefits Plan of California, UnitedHealthcare of Colorado, Inc., UnitedHealthcare of the MidAtlantic, Inc., MAMSI Life and Health Insurance Company, UnitedHealthcare of New York, Inc., UnitedHealthcare Insurance Company of New York, UnitedHealthcare of Oklahoma, Inc., UnitedHealthcare of Oregon, Inc., UnitedHealthcare of Pennsylvania, Inc., UnitedHealthcare of Texas, Inc., UnitedHealthcare Benefits of Texas,  \nInc., UnitedHealthcare of Utah, Inc., UnitedHealthcare of Washington, Inc., Optimum Choice, Inc., Oxford Health Insurance, Inc., Oxford Health Plans (N","cbCaioX7Ob1On92S","https://ap.wps.com/l/cbCaioX7Ob1On92S","pdf",78167,"English","# Submission instructions\n## Electronic submission via Provider Portal\n## Paper submission form requirements\n# Form fields\n## Member information\n## Physician/health care professional information\n## Reason for request\n## Comments and required attachments","[{\"question\":\"How can a provider submit a claim reconsideration electronically?\",\"answer\":\"Submit through the UnitedHealthcare Provider Portal by signing in, navigating to Claims \\u0026 Payments \\u003e Look up a Claim, finding the claim, going to the Act on a Claim section, and selecting the available option to create a reconsideration. Complete the fields, attach supporting documents, and submit.\"},{\"question\":\"Can the paper form be used for multiple claims or bulk submission?\",\"answer\":\"No. The paper form is for submitting one claim at a time and should not be used for bulk or multiple claims. Submit a separate form for each claim.\"},{\"question\":\"What does the form require for the reconsideration reason and attachments?\",\"answer\":\"Select a reason for the request from the listed options and include comments when applicable. Attach required documents such as a copy of the PRA or EOB as support for the request.\"}]","UHC Claim Reconsideration Form - Submit a Request | PDF",1789514609]