Claim adjustment

Our website no longer supports Internet Explorer. For the best browsing experience, we recommend using Chrome, Safari, Edge or Firefox.

Adjustment reason requests include additional or corrected data that was not on the original claim.

Use our Quick Claim Submission Guide to review guidelines for common claim scenarios.

Attention Minnesota providers!

Minnesota Statute section; 62J.536 requires Minnesota providers to submit adjusted claims in the electronic 837 format.

Adjustment reason

* Provider name

* Tax ID NPI

* First name

* Last name

* Phone #

Ext.

Fax #

* Email

* Product type

HealthPartners Commercial products HealthPartners Government and Senior products HealthPartners Dental

* Member first name

* Member last name

* Member #

* Claim #

* Date of service

* Billed charges

Attach documentation to support your request

The file/s have been attached and will be submitted with this form, but the attached file names are not available to display at this time.

You may continue and submit this form if you have attached the appropriate documentation, or click cancel to start over.

Less than one Megabyte attached (Maximum 20MB) {{totalAttachLength | number:2}} Megabytes attached (Maximum 20MB)

Description of claim adjustment request