Form preview

Get the free International Claims Transmittal Form

Get Form
We are not affiliated with any brand or entity on this form
Illustration
Fill out
Complete the form online in a simple drag-and-drop editor.
Illustration
eSign
Add your legally binding signature or send the form for signing.
Illustration
Share
Share the form via a link, letting anyone fill it out from any device.
Illustration
Export
Download, print, email, or move the form to your cloud storage.

Why pdfFiller is the best tool for your documents and forms

GDPR
AICPA SOC 2
PCI
HIPAA
CCPA
FDA

End-to-end document management

From editing and signing to collaboration and tracking, pdfFiller has everything you need to get your documents done quickly and efficiently.

Accessible from anywhere

pdfFiller is fully cloud-based. This means you can edit, sign, and share documents from anywhere using your computer, smartphone, or tablet.

Secure and compliant

pdfFiller lets you securely manage documents following global laws like ESIGN, CCPA, and GDPR. It's also HIPAA and SOC 2 compliant.
Form preview

What is international claims transmittal form

The International Claims Transmittal Form is a health insurance claim document used by UnitedHealth Group members to submit medical bills for treatment received abroad.

pdfFiller scores top ratings on review platforms

Users Most Likely To Recommend - Summer 2025
Grid Leader in Small-Business - Summer 2025
High Performer - Summer 2025
Regional Leader - Summer 2025
Show more Show less
Fill fillable international claims transmittal form: Try Risk Free
Rate free international claims transmittal form
4.5
satisfied
37 votes

Who needs international claims transmittal form?

Explore how professionals across industries use pdfFiller.
Picture
International claims transmittal form is needed by:
  • UnitedHealth Group members seeking reimbursement for foreign medical care.
  • Healthcare providers submitting claims for international patients.
  • Expats who require coverage for overseas healthcare services.
  • Insurance agents assisting clients with international claims submissions.
  • Billing departments needing to process claim forms for patients abroad.

How to fill out the international claims transmittal form

  1. 1.
    To begin, visit pdfFiller.com and log in or create an account if you don't have one.
  2. 2.
    In the search bar, type 'International Claims Transmittal Form' to find the form quickly.
  3. 3.
    Once you locate the form, click on it to open in the pdfFiller interface.
  4. 4.
    Gather all required information including your UnitedHealth Group member ID, details about the patient, healthcare provider, and service provided.
  5. 5.
    Use the fillable fields to enter your personal information accurately, including contact details and medical provider information.
  6. 6.
    Check the form for any necessary checkboxes indicating the type of service or treatment received.
  7. 7.
    Be sure to review all sections of the form for completeness before moving on.
  8. 8.
    If needed, use the instructions provided within the form for guidance on specific fields.
  9. 9.
    Once all the information is filled out and verified, save your progress, and consider downloading a copy for your records.
  10. 10.
    To finalize, submit the completed form by mail to the specified address in Atlanta, Georgia, as indicated in the form instructions.
Regular content decoration

FAQs

If you can't find what you're looking for, please contact us anytime!
UnitedHealth Group members who have received medical treatment abroad can use this form to seek reimbursement for their expenses.
You typically need to provide detailed medical bills, proof of payment, and any necessary information about the healthcare provider alongside the completed claim form.
While specific deadlines may vary, it is advisable to submit your claims as soon as possible after treatments to ensure timely processing of your reimbursement.
You must print the completed form and submit it by mail to the specified address in Atlanta, Georgia. Electronic submissions may not be accepted for this form.
Ensure all information is accurate and complete, including member ID and provider details. Double-check for empty fields and missing signatures to prevent processing delays.
Processing times can vary, but typically, claims are reviewed within a few weeks. You can follow up with UnitedHealth Group for status updates.
No, notarization is not required for the International Claims Transmittal Form, making the process quicker and more accessible.
If you believe that this page should be taken down, please follow our DMCA take down process here .
This form may include fields for payment information. Data entered in these fields is not covered by PCI DSS compliance.