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Cancel Claim Submission?
Are you sure you want to cancel your claim submission?
Cancel Claim Submission?
Opening this page will cancel the submission process and you will lose all information entered. Are you sure?
Provider
Please enter the name of the provider who rendered the services.
Enter Claim Information
We're happy to process your claim for you. Please provide your claim information below. A separate claim should be submitted for each:
- Member
- Provider
- Claim Currency
At the end of this process you will receive a claim submission number.
All fields marked with an asterisk (*) are required.
Member is required.
Provider is required.
Provider name allows only alphanumeric characters and ! # $ & ( ) " , . / : ; @ [] \ _ ` ‘ ’ “ ” + ' \ - – Ž Α Β Ε Η Θ Ι Ξ Ο Π Ρ Σ Τ Ω ◻
Provider Country is required.
Please enter a valid country name.
Provider Country allows only alphabetic characters and . - & ' ( ) , Å ô é
Please note, if your claim was incurred in the United States, you will not view it here on the Global Gateway. Please visit myuhc.com to view your U.S. claims.
Provider City is required.
Provider City allows only alphanumeric characters and . - & ; ' ,
Claim Nickname allows only alphanumeric characters and . - & ; ',
Billed Amount is required.
Billed Amount must be a valid number.
Billed Amount must be greater than zero.
Claim Currency is required.
Please enter a valid currency.
Claim Currency allows only alphabetic characters and . - & '
Date of Service is required.
Date of Service cannot be a future date.
Please provide the member's diagnosis (for example: strep throat, back pain) or, if available, the ICD10 diagnosis code from your invoice.
150
Diagnosis is required.
Diagnosis allows only alphanumeric characters and . - & ; ' ,
Please provide a brief description of the treatment or services received (for example: office visit plus blood work).
250
Description of Treatment is required.
Description of Treatment allows only alphanumeric characters and . - & ; ' ,