United Healthcare Digital HRA Entry (Report issues with completing HRA's)

United Healthcare Digital HRA Entry (Report issues with completing HRA's)
PLEASE READ:

IN ORDER TO ALLOW UHC SUPPORT TIME TO RESOLVE ISSUES, THE DEADLINE TO SUBMIT THIS FORM IS:

The 25th of each month by 3:00pm EST

After the deadline, no issue submissions will be sent to UHC for resolution. Apologies in advance.
Please select your CPESN Network:*
Pharmacy Name:*
Pharmacy NPI Number:*
Email Address:*
[email protected]
Phone Number:*
Please enter a valid phone number.
If the issue is related to a patient, please complete the member information below and continue. If not, skip to the field to describe the issue you are having.
Member First and Last Name:

First NameLast Name
Please enter the Member MBI Number:
Please enter the Member Date of Birth:

MonthDayYear
Date
Please describe the issue you are having or error you are receiving: *
Upload a screenshot of your issue if available: (Optional)

Cancelof
Is there any additional information you would like to add?*
Should be Empty: