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Claim Reconsideration Request Form

A Claim Reconsideration request is typically the quickest way to address any concern you have with how we processed your claim. With a Claim Reconsideration request, we review whether a claim was paid correctly, including if your provider information and/or contract are set up incorrectly in our system, which could result in the original claim being denied or reduced.

There are several ways to submit a Claim Reconsideration Request.

1. Submit an electronic Claim Reconsideration Request with attachments on Optum Cloud Dashboard. For information on registering for access to the Optum Cloud Dashboard, see the Administrator Registration and Importing Users Quick Reference Guide.

By using this method, you can:

  • Reduce the overall turnaround time for the request.
  • Receive immediate confirmation and a unique tracking number to show we received your request.
  • Check submission status throughout the process.

To learn more, view the Optum Cloud Dashboard Claim Reconsideration with Attachments Quick Reference Guide.

2. Submit a Claim Reconsideration without attachments via the Claim Reconsideration function on UnitedHealthcareOnline.com. You'll be notified that your request was received. View the Claim Reconsideration Quick Reference Guide for more information.

3. Paper Claim Reconsideration Request forms can be downloaded from:

Where to send the paper Claim Reconsideration Requests:
For UnitedHealthcare/UnitedHealthcare West,
if your request for a claim reconsideration is for a commercial or Medicare member, send the paper Claim Reconsideration Requests to one of the following:

  • the address on the Explanation of Benefits (EOB) or the Provider Remittance Advice (PRA)
  • the claim address on the back of the member's ID card

For UnitedHealthcare Empire Plan, send to:
P.O. Box 1600
Kingston, NY 12402-1600

For UnitedHealthcare Community Plan, if your request for a claim reconsideration is for a Medicaid/Chip member, use the Community Plan Claim Reconsideration Mailing Addresses document to find the correct address.

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