NJ Medicaid: Consent form required with sterilization claims

UnitedHealthcare Community Plan of New Jersey requires a completed Consent Form-7473-M ED 3-81 for all sterilization procedures per state requirements. The completed, signed form must be submitted with all related claims, including hospital, physician, anesthesiology and clinic claims. Claims submitted without the required consent form will be denied.

What this means for you

• Paper claims: Attach the completed consent form to the mailed claim submission 
• Electronic claims: Follow your clearinghouse’s process for attaching the completed consent form to the claim

Questions? We’re here to help.

Connect with us through chat 24/7 in the UnitedHealthcare Provider Portal, or call Provider Services at 888-362-3368, Monday–Friday, 8 a.m.–6 p.m. ET.