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Provider dispute resolution po box 30539 salt lake city, ut 84130 note: Web optum behavioral health reconsideration request form; This form is for claim disputes and reconsiderations only. All outpatient and eap claims should be submitted electronically. Web an appeals representative is standing by ready to help via chat monday thru friday, 7:00 a.m.
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Web download the form below and mail or fax it to unitedhealthcare: See the prior authorization grid for a list of this year's services. Web or mail the completed form to: You will now be able to download any documentation. Web an appeals representative is standing by ready to help via chat monday thru friday, 7:00 a.m.
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