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Check Claim Status – Saint Augustine’s University

If you are a student and would like to check on the status of a claim that you or a provider submitted to UnitedHealthcare, you will need to set up a My Account if you have not already done so.

Please visit our My Account center to log in to an existing account or to create a new one.

File a Medical Claim – Saint Augustine’s University


Submit a Claim by Mail

It’s easy! Just download the claim form below. Fill out the first page with your personal information, dates of injury or sickness, the cause of the injury or date of first symptoms for a sickness, sign your name with today’s date, and attach all receipts. Please fill out the entire first page and be sure not to leave anything blank.

Mail Claim Forms to:
FIRSTSTUDENT
P.O. Box 809025
Dallas, TX 75380-9025

Medical Claim Form

Submit a Claim Electronically

Your Doctor can also submit a claim electronically using Emedeon (formerly WebMD). This gives a faster turn-around time than submitting a claim by mail. Check with your doctor to see if they are a participant. If they are, show them your ID Card. The Emedeon information is printed on the back of every ID Card.

If you have any problems filling-out these forms or would like to talk to a customer service representative, you can call us toll free at: 1-800-505-4160 or

CONTACT US

File a Prescription Claim – Saint Augustine’s University

If you would like to submit a paper claim for reimbursement for a prescription that you paid for out of pocket, please print a copy of the Generic Reimbursement Claim Form located below.

After filling out the necessary information, please read the acknowledgement carefully (located at the bottom of page) and sign and date in the space provided.

To submit a Generic Reimbursement Claim Form, please be sure your receipts are complete. In order for your request to be processed, all receipts must contain the information listed below:

  • Date prescription filled
  • Name and address of pharmacy
  • Doctor name or ID number
  • NDC number (drug number)
  • Name of drug and strength
  • Quantity and days’ supply
  • Prescription number (Rx number)
  • DAW (Dispense As Written)
  • Amount paid

This information can usually be found on the receipt which is stapled on the outside of the packaging or in some cases located inside. Your pharmacist can provide the necessary information as well.

Please mail completed form and receipt(s) to:

OptumRx Claims Department

P.O. Box 29044

Hot Springs, AR 71903

File an Appeal – Saint Augustine’s University

To file an appeal, please include the following information:

  1.  A letter requesting an appeal to your claim(s), including your:
    • Name,
    • Address,
    • Phone number,
    • UnitedHealthcare Student ID number,
    • Date of service for your injury/sickness,
    • Claim number(s) (located on the top of your Explanation of Benefits), and
    • Email address.
  2. A copy of your Explanation of Benefits for the claim(s) in question.
  3. Medical Records including all test results from all providers visited for the specific injury/sickness that you are appealing.

Once we receive the documentation, your appeal will be reviewed and a written response will be mailed to you. The response will include what the findings were, if the appeal was approved or denied, and the reason for the final decision.

If you have a question about your claim denial, you may call our Customer Service Department at telephone number 1-800-505-4160 for further explanation to informally resolve your appeal. If you are not satisfied with our explanation of why the claim was denied, you or your authorized representative may request an internal review of the claim denial. (For more information about an authorized representative, please click on “forms” on the left.)

File a Medical Claim – Dominican University of California


Submit a Claim by Mail


It’s easy! Just download the claim form below. Fill out the first page with your personal information, dates of injury or sickness, the cause of the injury or date of first symptoms for a sickness, sign your name with today’s date, and attach all receipts. Please fill out the entire first page and be sure not to leave anything blank.

Mail Claim Forms to:
FIRSTSTUDENT
P.O. Box 809025
Dallas, TX 75380-9025

Medical Claim Form


Submit a Claim Electronically


Your Doctor can also submit a claim electronically using Emedeon (formerly WebMD). This gives a faster turn-around time than submitting a claim by mail. Check with your doctor to see if they are a participant. If they are, show them your ID Card. The Emedeon information is printed on the back of every ID Card.

If you have any problems filling-out these forms or would like to talk to a customer service representative, you can call us toll free at: 1-800-505-4160 or

CONTACT US

Check Claim Status – Dominican University of California

If you are a student and would like to check on the status of a claim that you or a provider submitted to UnitedHealthcare, you will need to set up a My Account if you have not already done so.

Please visit our My Account center to log in to an existing account or to create a new one.

File a Prescription Claim – Dominican University of California


If you would like to submit a paper claim for reimbursement for a prescription that you paid for out of pocket, please print a copy of the Generic Reimbursement Claim Form located below.

After filling out the necessary information, please read the acknowledgement carefully (located at the bottom of page) and sign and date in the space provided.

To submit a Generic Reimbursement Claim Form, please be sure your receipts are complete. In order for your request to be processed, all receipts must contain the information listed below:

  • Date prescription filled
  • Name and address of pharmacy
  • Doctor name or ID number
  • NDC number (drug number)
  • Name of drug and strength
  • Quantity and days’ supply
  • Prescription number (Rx number)
  • DAW (Dispense As Written)
  • Amount paid

This information can usually be found on the receipt which is stapled on the outside of the packaging or in some cases located inside. Your pharmacist can provide the necessary information as well.

Please mail completed form and receipt(s) to:

OptumRx Claims Department

P.O. Box 29044

Hot Springs, AR 71903

File an Appeal – Dominican University of California

To file an appeal, please include the following information:


  1. 1.  A letter requesting an appeal to your claim(s), including your:
    • Name,
    • Address,
    • Phone number,
    • UnitedHealthcare Student ID number,
    • Date of service for your injury/sickness,
    • Claim number(s) (located on the top of your Explanation of Benefits), and
    • Email address.

  2. 2. A copy of your Explanation of Benefits for the claim(s) in question.

  3. 3.Medical Records including all test results from all providers visited for the specific injury/sickness that you are appealing.


Once we receive the documentation, your appeal will be reviewed and a written response will be mailed to you. The response will include what the findings were, if the appeal was approved or denied, and the reason for the final decision.

If you have a question about your claim denial, you may call our Customer Service Department at telephone number 1-800-505-4160 for further explanation to informally resolve your appeal. If you are not satisfied with our explanation of why the claim was denied, you or your authorized representative may request an internal review of the claim denial. (For more information about an authorized representative, please click on “forms” on the left.)

File a Prescription Claim – Olin College of Engineering

If you would like to submit a paper claim for reimbursement for a prescription that you paid for out of pocket, please print a copy of the Generic Reimbursement Claim Form located below.

After filling out the necessary information, please read the acknowledgement carefully (located at the bottom of page) and sign and date in the space provided.

To submit a Generic Reimbursement Claim Form, please be sure your receipts are complete. In order for your request to be processed, all receipts must contain the information listed below:

  • Date prescription filled
  • Name and address of pharmacy
  • Doctor name or ID number
  • NDC number (drug number)
  • Name of drug and strength
  • Quantity and days’ supply
  • Prescription number (Rx number)
  • DAW (Dispense As Written)
  • Amount paid

This information can usually be found on the receipt which is stapled on the outside of the packaging or in some cases located inside. Your pharmacist can provide the necessary information as well.

Please mail completed form and receipt(s) to:

OptumRx Claims Department

P.O. Box 29044

Hot Springs, AR 71903

Check Claim Status – Olin College of Engineering

If you are a student and would like to check on the status of a claim that you or a provider submitted to UnitedHealthcare, you will need to set up a My Account if you have not already done so.

Please visit our My Account center to log in to an existing account or to create a new one.