Provider Forms and References

OBRAF Electronic Form in the UnitedHealthcare Provider Portal
Access and complete the online form on the portal. Go to UnitedHealthcare Provider Portal and go to Clinical & Pharmacy in the top menu bar > Care Conductor and Notification of Pregnancy > Obstetrical Risk Assessment Form.
OBRAF Faxable Form
Prior Authorization Forms
Sterilization Consent Form
In accordance with Title 42 Code of Federal Regulations (CFR) 441 Subpart F, all sterilizations require a valid consent form.

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Submit a Pre-Service Appeal and or Grievance for a Medicaid Member