UMR Inquiry Form

SHO UM will respond within 3 business days to urgent inquiries and
14 business days to routine inquiries.

For UMR use only

Request Type:

Submitter’s Contact Information:

Patient’s Information:

Is the request for Inpatient or Outpatient services (please check one)
Inquiry Category (please check one)

Need additional assistance assitance? Please send message to: nvshomailbox@ds.uhc.com