Legal Billing Record Requests

For each request submit by email, fax or mail with the UW Medicine Auth to Disclose PHI form.

If a non-UW Medicine Auth to Disclose PHI form is submitted, then you must authorize “UW Medicine” as the releasing entity.

• Email: passroi@uw.edu
• Fax: 206.598.0842
• Mail: UW Medicine Patient Accounts & Support Services
  7527 63rd Ave NE – Bldg. 5C
  Seattle, WA 98115-8154

To pay for billing requests by credit card, use our secure online payment portal.

• Limit up to twenty (20) invoices for each payment submission. Place commas after each Release ID if submitting more than one request.

To pay for billing requests by check, make payment payable to UW Medicine and mail to:

• UW Medicine Patient Accounts & Support Services
  7527 63rd Ave NE – Bldg. 5C
  Seattle, WA 98115-8154

View a sample Billing Record invoice.

Email billing record refund requests to: passroi@uw.edu

Complete the UW Medicine Auth to Disclose PHI form

Email form to: passroi@uw.edu

Complete the UW Medicine Auth to Disclose PHI form and Settlement Reduction-Waiver Request form

Email forms to: passroi@uw.edu

• Contact Patient Accounts and Support Services Customer Service at 206.520.0400:
  • To update coverage/bill insurance.
  • Was my client’s insurance billed?
  • Does my client have dates of service pending insurance?
  • Can you assist with general questions related to a claim denied/pending insurance?
    • For more specific questions contact the insurance directly.
  • For coordination of benefits, e.g., why was one insurance billed over another?
  • Can you add an insurance coverage to my client’s account?
    • Updating over the phone is the fastest way to add a coverage.
    • If you need to submit this update in writing, fax to 206.520.0499.
• Contact passroi@uw.edu:
  • Itemized Billing, Balance Verification, or Settlement requests.
  • Health Information Technology for Economic and Clinical Health (HITECH) requests written and signed by patient.
• Contact the insurance company:
  • To obtain Explanation of Benefits (EOBs) with information such as claim numbers, payment dates, and denial reasons.
  • For claims questions and explanations of payment (examples below):
    • Denials for insurance questionnaire form.
    • Disputes regarding coordination of benefits/filing order.
    • Assistance with claims still pending insurance.

• Medical Record
• Patient Billing
  • Contact Patient Accounts and Support Services Customer Service at 206.520.0400 or 1.855.520.0400.
  • Message us through MyChart.

Your billing record statement will provide the collection agency contact information.

• Standard turnaround time is fourteen (14) business days. 
• You can check on the status if it has been greater fourteen (14) business days via email at passroi@uw.edu.
• For status checks include the following information within your email:
  • On the subject line state “status check”.
  • Specify the UW Medicine location(s)
    • Harborview Medical Center & Clinics
    • UW Medical Center – Montlake & Clinics
    • UW Medical Center – Northwest & Clinics
    • UW Physicians (includes UW Medicine Primary Care and Hall Health)
• Dates of service(s) for the visit or procedure.
• Date the request was submitted.
• Type of request submitted (billing record or settlement).
• How was the request submitted (email, fax, or mail).

UW Medicine provides financial assistance to Washington state residents. Assistance is available to the insured and uninsured based on income and family size. For more information visit our website at uwmedicine.org/financialassistance.

• The most common reason why charges may be missing from the billing statement or balance verification is due to telehealth visits with a social worker. These charges were unbillable during the pandemic.
• If other types of charges are missing, submit a request via email at passroi@uw.edu. Allow at least thirty (30) days for a review.

• Washington state law allows minors thirteen (13) years or older to make their own medical decisions.
• For patients younger than eighteen (18), unless the patient is emancipated (and we have legal documentation in the patient’s file reflecting the emancipation), the patient’s parent or legal guardian must sign on behalf of the patient.
• A minor patient’s signature is required to release the following information:
  • Conditions related to the minor’s reproductive health, and sexually transmitted infection (if age fourteen (14) and older); and
  • Alcohol and/or drug abuse, and mental conditions (if age thirteen (13) and older).
• For deceased patients, submit a UW Medicine Auth to Disclose PHI form or a Non-UW Medicine form signed by the patient’s surviving spouse or legal representative.
• All individuals signing for disclosure of PHI must state their relationship to the patient and may be required to provide proof of legal authority to permit the use or disclosure of the medical information.