Claim Status Request Form

To submit a claim status request, please complete the below form in its entirety and a representative will reach out to you and provide an update or send you an Explanation of Sharing.

Member's Claim Status Request

Member's Name

Member's ID / DOB

Member's Phone:

Date of service:

Provider or Facility Name:

Total Amount Billed:

Date Submitted to URHS:

Form of Submission:

Mail Email Fax Upload

Comments

Member's Claim Status Request

Please note: Enrollment for June membership ends on May 10th.

Please note:
Enrollment for June membership ends on May 10th.