New Jersey Medicaid: Consent form required with any sterilization claim

UnitedHealthcare Community Plan of New Jersey requires a completed Consent Form-7473-M ED 3-81 attached to any claim (hospital, operating physician, anesthesiologist, clinic, etc.) involved in a sterilization procedure per state guidelines. Without the fully completed, signed consent form attached to the claim, payment shall be denied. 

Next steps

When mailing a claim for a sterilization procedure, attach the completed consent form to the paper claim. When submitting an electronic claim for sterilization procedures, follow the clearing house steps to attach the completed consent form with the claim.

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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. Eastern Time. For additional contact information, visit our Contact us page.

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