If you need to correct and re-submit a claim, submit a new CMS-1500 or UB-04 indicating the correction being made.
When correcting or submitting late charges on a CMS-1500, UB-04 or 837 Institutional claim, resubmit all original lines and charges as well as the corrected or additional information. When correcting UB-04 or 837 Institutional claims, use bill type xx7, Replacement of Prior Claim. Do not submit corrected or additional charges using bill type xx5, Late Charge Claim. Hand-corrected claim re-submissions will not be accepted.
Electronic Claim Submission
(EDI Support Line)
To obtain information on HIPAA Transactions & Code sets go to hipaa.uhc.com Uniprise
Companion Document Additional United Healthcare and Affiliates’ payer ID scan be found on UnitedHealthcare Online.com
Claims & Payments Electronic Claims
Submissions, under EDI Tools & Resources
- CMS 1500 claim form - How to fill out correctly - Instruction
- Referring provider, Ordering provider and billing ...
- Medicare provider Enrollment question and answer part 1
- Medicare Enrollment - question and answer part 2
- Complete claim submission - some tips
- Medicare Deductible FAQ
- Secondary claim submission CMS 1500 requirements
- UB 04 - Complete instruction to fill the form
The other ID number of the referring provider, ordering provider, or other source should be reported in 17a in the shaded area. The qualifie...
Item 17 Enter the name of the referring or ordering physician if the service or item was ordered or referred by a physician. All physicia...
For Adjustments: When requesting an adjustment to a paid claim, enter an “A” followed by the 13-character internal control number (ICN) as...
Item 21 - Enter the patient's diagnosis/condition. With the exception of claims submitted by ambulance suppliers (specialty type 59), al...
Bottom section of the CMS 1500 form Supplemental information Shaded line �� In the shaded area across Fields 24A through 24H, enter s...
Billing instruction for Ambulance Billing - Box 20 to 23 BlockNo. Block Name Block Code Notes ...
When submitting attachments with the CMS-1500 claim form, please follow these guidelines: Any attachment should be marked with the benef...
Click the image for see full size sample CMS 1500 claim form. Claim Form Sample
TWO-DIGIT QUALIFIERS The shaded fields in boxes 17a, 24I, 24J, 32b and 33b should be used to report provider numbers other than the NPI as...