Request a Claim Adjustment

Submit a Claim Adjustment Online

• Claim Adjustment Request Online (Requires Login)

Request by Mail

Fill out the form below and return to Univera Healthcare by mail.

• Claim Adjustment Request Mail

Overpayment Procedures

Please fill out attached Overpayment Return Form and send to:

Univera Overpayment FormOpen XLS Document

Please include the claim number, member ID number, reason for the refund and the date of service or a copy of the applicable remittance with the overpayment.

Please do not return overpayments for claims involving NYHCRA pools. Notify us in writing at the address listed above and be sure to include a copy of the remittance in question so that we may initiate a retraction.