Cytokine and CAM Antagonists [Actemra, Cimzia, Remicade] (Pennsylvania Medicaid Only) Prior Authorization Form - Community Plan

Use this paper fax form to submit requests for the following state plans: Pennsylvania UnitedHealthcare Community Plan for Families

Hepatitis C Medications (Hawaii) Prior Authorization Form - Community Plan

Use this paper fax form to submit requests for the following state plans: Hawaii UnitedHealthcare Community Plan QUEST Integration Program

Sutent (Washington) Prior Authorization Form - Community Plan

Use this paper fax form to submit requests for the following state plans: Washington UnitedHealthcare Community Plan

Votrient (Washington) Prior Authorization Form - Community Plan

Use this paper fax form to submit requests for the following state plans: Washington UnitedHealthcare Community Plan

Hepatitis C Medications (New Jersey) Prior Authorization Form - Community Plan

Use this paper fax form to submit requests for the following state plans: New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program

Imbruvica (Washington) Prior Authorization Form - Community Plan

Use this paper fax form to submit requests for the following state plans: Washington UnitedHealthcare Community Plan

UnitedHealthcare Commercial Advance Notification/Prior Authorization Requirements - Effective August 1, 2020

This list contains notification/prior authorization review requirements for care providers who participate with United Healthcare Commercial for inpatient and outpatient services.

UnitedHealthcare Commercial Advance Notification/Prior Authorization Requirements - Effective September 1, 2020

This list contains notification/prior authorization review requirements for care providers who participate with United Healthcare Commercial for inpatient and outpatient services.

UnitedHealthcare Commercial Advance Notification/Prior Authorization Requirements - Effective Jan. 1, 2021

This list contains notification/prior authorization review requirements for participating care providers for inpatient and outpatient services, as referenced in the 2021 UnitedHealthcare Care Provider Administrative Guide. Updates to the list are ...

UnitedHealthcare Commercial Advance Notification/Prior Authorization Requirements - Effective October 1, 2020

This list contains notification/prior authorization review requirements for care providers who participate with United Healthcare Commercial for inpatient and outpatient services.

UnitedHealthcare Commercial Advance Notification/Prior Authorization Requirements - Effective November 1, 2019

This list contains notification/prior authorization review requirements for participating care providers for inpatient and outpatient services, as referenced in the 2019 UnitedHealthcare Care Provider Administrative Guide. Updates to the list are ...

UnitedHealthcare Commercial Advance Notification/Prior Authorization Requirements - Effective November 1, 2020

This list contains notification/prior authorization review requirements for care providers who participate with United Healthcare Commercial for inpatient and outpatient services.

UnitedHealthcare Commercial Advance Notification/Prior Authorization Requirements - Effective Feb. 1, 2021

This list contains notification/prior authorization review requirements for participating care providers for inpatient and outpatient services, as referenced in the 2021 UnitedHealthcare Care Provider Administrative Guide. Updates to the list are ...

UnitedHealthcare Commercial Advance Notification/Prior Authorization Requirements - Effective Dec. 1, 2019

This list contains notification/prior authorization review requirements for participating care providers for inpatient and outpatient services, as referenced in the 2019 UnitedHealthcare Care Provider Administrative Guide. Updates to the list are ...

UnitedHealthcare Commercial Advance Notification/Prior Authorization Requirements - Effective 3/1/2020

This list contains notification/prior authorization review requirements for care providers who participate with United Healthcare Commercial for inpatient and outpatient services.

UnitedHealthcare Commercial Advance Notification/Prior Authorization Requirements - Effective March 1, 2021

This list contains notification/prior authorization review requirements for participating care providers for inpatient and outpatient services, as referenced in the 2021 UnitedHealthcare Care Provider Administrative Guide.