Skip to main content
Sutter Health logo
  • Member
  • Employer
  • Provider
  • Select language
    • English
    • Español
    • 中文
sign-in image Sign in
  • Home
  • Member
  • Employer
  • Provider
  • Find a provider
  • Form center
  • Select language
    • English
    • Español
    • 中文
  • Home
  • Find a provider
  • Form center
Sign in
  1. Home chevron_right
  2. Form Center
Hero banner
Hero banner

Forms

Not all forms apply to your benefits plan. Sign in to your account to find specific forms relating to your coverage. If you have any questions about which forms or documents you may need, please call the toll–free number on your health plan ID card.

Select who you are

form
I am... to your account
search
Form name
pdf Authorization for Release of Health Information Form (UMF0023)
pdf Continuity of Care Form (UMF0005)
pdf GUIDE: How to access the UMR Post-Service Appeal Request Form (UM1398)
pdf Member Medical Claim Submission Form (UMF0022)
pdf Member Vision Claim Submission Form (UMF0056)
pdf Patient Rights Summary
pdf Peer-to-Peer Request Form (UMF0057)
pdf Post-Service Appeals Designation of Authorized Representative (UMF0018)
pdf Post-Service Appeal Request Form (UMF0010)
pdf Pre-determination of Benefits Request Form
pdf Pre-determination Form (UMF0060)
pdf Pre-Service Appeals Designation of Authorized Representative (UMF0011)
pdf Privacy Complaint Form
pdf Provider Medical Claim Submission Form
pdf Provider Remittance Advice (RA) Form (UMF0025)
pdf Request for an Accounting of Disclosures of Protected Health Information
pdf Request for Amendment of Protected Health Information
pdf Request for Confidential Communication Form (UMF0024)
pdf Revocation of Request for Confidential Communications of Protected Health Information


To top
  • Continuity of care
    (Opens in a New Tab)
  • Privacy policy
    (Opens in a New Tab)
  • Terms of use
    (Opens in a New Tab)
  • Texting terms of use
    (Opens in a New Tab)
  • Conflict of interest
    (Opens in a New Tab)
  • Editorial policy
    (Opens in a New Tab)
  • Accessibility
    (Opens in a New Tab)
  • Surprise billing
    (Opens in a New Tab)
  • Report fraud
    (Opens in a New Tab)
  • Contact us
    (Opens in a New Tab)
  • Careers
    (Opens in a New Tab)
  • Out-of-network payment information
    (Opens in a New Tab)
©2025 United HealthCare Services, Inc.
  • Continuity of care
  • Privacy policy
  • Terms of use
  • Texting terms of use
  • Conflict of interest
  • Editorial policy
  • Accessibility
  • Surprise billing
  • Report fraud
  • Contact us
  • Careers
  • Out-of-network payment information
©2025 United HealthCare Services, Inc.