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Get Unitedhealthcare Appeal Form Pdf

In benefit plans administered by UnitedHealthcare. NOTE: Please submit a separate claim reconsideration request form for each claim reconsideration request No new claims should be submitted with this form. Do not use this form for formal appeals or disputes. Continue to use your standard appeals process for formal appeals or disputes. Please refer to the Claim Reconsideration cover sheet or your provider administrative manual for additional details including where to send Claim Reconsideration.

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