Provider Forms and References | UnitedHealthcare Community Plan of Minnesota

• Disclosure of Ownership and Control Interest of an Entity - Online Version
  
• Provider Disclosure of Ownership and Control Interest Statement FAQ

• Critical Incidents Report Form
• Community Plan of Minnesota Notification of Pregnancy and Risk Assessment form
• Community Plan of Minnesota Restricted Recipient Program Enrollee Referral Form
  
• Community Plan of Minnesota Restricted Recipient Program Patient Referral Request Form
• Synagis Enrollment Form

• Behavioral Health Home Services Form (must be signed in to use)
• Health Care Home Services Form (must be signed in to use)

Contact Provider Call Center 1-877-440-9946, available from 8:00 a.m. - 5:00 p.m. Central Time.