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UnitedHealthcare (UHC) Out of Network Claim …

UnitedHealthcare (UHC) Out of Network Claim Submission instructions For Medical and Mental Health Claims Clean and Unclean Claims Because UnitedHealthcare processes claims according to state and federal requirements, a clean Claim is defined as a complete Claim or an itemized bill that does not require any additional information to process it. A clean Claim includes at least all of the following*: Patient name and UnitedHealthcare Member ID number UnitedHealthcare provider ID number Provider information, including federal tax ID number (FTIN). Date of service (DOS). Place of service Diagnosis code Procedure code Individual charge for each service Provider signature *More specific requirements are set forth below.

UnitedHealthcare (UHC) Out of Network Claim Submission Instructions Clean and Unclean Claims Because UnitedHealthcare processes claims according to state and federal requirements, a “

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