Attention New Jersey Providers: Consent Form Now Mandatory for Sterilization Claims Under Medicaid

Claims involving sterilization procedures submitted to UnitedHealthcare Community Plan of New Jersey must include a completed Consent Form-7473-M ED 3-81. This requirement applies to all providers (hospital, operating physician, anesthesiologist, clinic, etc.) per state guidelines. Claims submitted without a fully completed, signed consent form will be denied.

Steps for Submission:

For sterilization claims submission, make sure to complete the consent form attached as follows:

• Paper Claims: Make sure to attach the consent form directly to the mailed claim.
• Electronic Claims: Strictly follow clearinghouse instructions to include the consent form with the submission.

For more information on this healthcare providers can consult with UnitedHealthcare via their 24/7 chat feature available in the UnitedHealthcare Provider Portal.