Oxford Health Plans, New York insured

Source: https://uhc-gpd-green.uhc.com/content/dam/uhcdotcom/en/IndividualAndFamilies/PDF/Ox-NY-Medical-Claim-Form.pdf

Read date: 10-09-2026

Research steps

1. Confirm that the insured New York plan includes an out-of-network benefit. The Oxford New York form is expressly for out-of-network claims. Oxford New York Medical Claim Form
2. Complete Oxford Medical Claim Form M57295-A 12092 R1. Complete every applicable field and all Provider Information fields. A provider may complete the Provider Information section. Oxford New York Medical Claim Form
3. Attach a Superbill or Invoice with patient name, dates of service, ICD-10 diagnosis codes, CPT or HCPC procedure codes and modifiers, units, billed amount per procedure, and place of service. Attach payment receipts and a primary-plan EOB when applicable. Oxford New York Medical Claim Form
4. Leave the Assignment of Benefits box unchecked to keep payment with the member. Check it only to request payment directly to the provider. Sign and date the form. Oxford New York Medical Claim Form
5. Portal upload NO. The public form directs only an offline route. Destination details are excluded. myuhc.com and the UnitedHealthcare app are published for EOBs and claim viewing, not Oxford member claim upload. Oxford New York Medical Claim Form UnitedHealthcare claims
6. NOT PUBLISHED: the generic claim deadline and Oxford-specific processing time. The controlling New York certificate governs. Review the EOB at myuhc.com after processing. Oxford New York Medical Claim Form

Filing facts

• Portal upload: NO
• Portal: myuhc.com and UnitedHealthcare app
• Portal path: NOT APPLICABLE: Oxford New York form directs the completed claim and attachments to an offline route
• Mail address: PLAN-DEPENDENT: Mail it to the address listed on the back of your health plan ID card.
• Fax: NOT PUBLISHED
• Attach: Patient name; dates of service; ICD-10 diagnosis codes; CPT or HCPC procedure codes with modifiers; units; billed amount for each procedure; place of service; provider name; provider address; service address; NPI; Tax ID; group or facility name
• File types: NOT APPLICABLE
• File size limit: NOT APPLICABLE
• Maximum files: NOT APPLICABLE
• One file or separate files: NOT APPLICABLE
• Confirmation: EOB after processing
• Status check: myuhc.com EOB and claim view; UnitedHealthcare app shows claims
• Processing time: NOT PUBLISHED: UnitedHealthcare says many claims process within 14 business days but does not identify an Oxford-specific time
• Member deadline: NOT PUBLISHED: controlling New York certificate determines the claim deadline
• Deadline basis: This row is New York insured only; ASO plans use the separate NJ, CT, and ASO form and plan terms
• Mental health route: Use the mental health number on the member ID card for plan-specific behavioral benefits; no different public self-file form or portal is published

Confirm the address, fax number or portal path on the insurer's own claims page before you send; read on 10-09-2026.