(all versions except
Pocket Internet Explorer
On web browser menu click "Tools" menu and select "Internet Options".
In the "Internet Options" window select the "Security" tab.
On the "Security" tab click on the "Custom level..." button.
When the "Security Settings - Internet Zone" dialog window opens, look for the "Scripting" section.
In the "Active Scripting" item select "Enable".
When the "Warning!" window pops out asking "Are you sure you want to change the settings for this zone?" select "Yes".
In the "Internet Options" window click on the "OK" button to close it.
Click on the "Refresh" button of the web browser to refresh the page.
On the web browser menu click on the "Customize and control Google Chrome" and select "Settings".
In the "Settings" section click on the "Show advanced settings..."
Under the the "Privacy" click on the "Content settings...".
Click on the "OK" button to close it.
Close the "Settings" tab.
Click on the "Reload this page" button of the web browser to refresh the page.
On the web browser menu click on the "Edit" and select "Preferences".
In the "Preferences" window select the "Security" tab.
Click on the "Reload the current page" button of the web browser to refresh the page.
On the web browser menu click "Tools" and select "Options".
In the "Options" window select the "Content" tab.
In the opened "Options" window click on the "OK" button to close it.
Click on the "Reload current page" button of the web browser to refresh the page.
On the web browser menu click "Tools" and select "Preferences".
In the "Preferences" window select the "Advanced" tab.
On the "Advanced" tab click on "Content" menu item.
In the opened "Preferences" window click on the "OK" button to close it.
Click on the "Reload" button of the web browser to refresh the page.
Health Risk Assessment
Patient Personal Health Records
Risk Stratification Assessment
Claim Research Project
Electronic Payments & Statements (EPS) and Single EOB
Fee Schedule Lookup
OneNet PPO Pricing Status
Outpatient Procedure Grouper (OPG)
Cardiology Notification & Authorization - Submission & Status
Notification/Prior Authorization Required Inquiry
Notification/Prior Authorization Status
Notification/Prior Authorization Submission
Prior Authorization Utilization Review Statistics
Oncology Authorization Submission & Status
OptumRx Prior Authorization Submission & Status
Radiology Notification & Authorization - Submission & Status
EDI Education for Electronic Transactions
Health Information Technology
Health Resources for Patients
News & Network Bulletin
Policies, Protocols and Guides
Products & Services
Training & Education
UnitedHealthcare Community Plan Resources
Advance and Admission Notification Requirements
Patient Safety Resources
Performance Measurement & Reporting
Patient Eligibility & Benefits
Claims & Payments
Tools & Resources
Print Friendly Version
Print this page
Select Landscape orientation from your browser settings to print the full page width.
EDI Transaction Support Form
This form should be used to report EDI related issues only. For UnitedHealthcareOnline.com issues, contact the Help Desk at 866-842-3278.
EDI Transaction Support Form
Use this form to report suspected problems with electronic submissions through a clearinghouse.
Examples of when to use this form:
Provider/Billing Service or Clearinghouse is receiving a rejection message.
Provider/Billing Service or Clearinghouse is experiencing formatting problems with the 837.
Provider/Billing Service or Clearinghouse checking claim status and claim is not on file.
= Required field
= Optional field
1. Contact Information
UHG Associate Contact Information(Person Reporting issue on behalf of the user).
Billing Provider NPI:
Form completed by:
2. Please select the Product that this issue is related to:
Select a Product:
Select a Product
UnitedHealthcare Community Plan
UnitedHealthcare Medicare Solutions
3. Please select the function that the issue is related to:
Select a Function:
Select a Function
270/271 Eligibility Inquiries
276/277 Claim Status Inquiries
278 Notification Inquiries
835 Electronic Remittance Inquiries
835 Electronic Remittance Missing
EFT Inquiries (UnitedHealthcare Community Plan)
EFT Missing (UnitedHealthcare Community Plan)
Claim Denied on EOB
Claim not on file
Claim not received
4. Please provide a detailed explanation of the issue including the rejection message if available:
5. Please complete the following information:
Date of Service:
Date EDI Transaction was Submitted:
Rendering Provider NPI:
Payer Trace Number:
If issue is impacting more than one member, only one member example should be provided.
Site Use Agreement
Copyright © 2015 UnitedHealth Group, Incorporated. All rights reserved.