How to submit your reconsideration or appeal, Oxford Level Funded plans (NJ and CT) - 2022 UnitedHealthcare Administrative Guide
If you disagree with claim payment issues, overpayment recoveries, pharmacy, medical management disputes, contractual issues or the outcome of your reconsideration review, send a letter requesting a review to:
Oxford Level Funded members:
P.O. Box 31393
Salt Lake City, UT 84131-0371
You must submit your claim reconsideration and/or appeal to us within 12 months (or as required by law or your Agreement), from the date of the original EOB or denial. The 2-step process allows for a total of 12 months for timely submission, not 12 months for step 1 and 12 months for step 2.
What to submit
As the health care provider of service, you submit the dispute with the following information:
Member’s name and health plan ID number
Specific item in dispute
Clear rationale/reason for contesting the determination and an explanation why the claim should be paid or approved. If you disagree with the outcome of the claim appeal, you may file for an arbitration proceeding. A description of this process is in your Agreement.