Option Care Health - Special Pharmacy Form

UHC – MEDICATION SOURCING EXPANSION PRESCRIBER ORDER FORM: Submit completed form and clinical documentation.

Uniform Prior Authorization Prescription Request, form (440-4992)

OAR 836-053-1205: Exhibit 1, Uniform Prior Authorization Prescription Request, form (440-4992)

Skilled Nursing Facilities: UnitedHealthcare Clinical and Therapy Request Form

UnitedHealthcare Clinical Services and Therapy Request Form

New Mexico Commercial Prescription Prior Authorization Form - UnitedHealthcare Commercial Plans

PDF fillable form for use in New Mexico.

Cometriq (Washington) Prior Authorization Form - Community Plan

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

Fentanyl Immediate Release (Washington) Prior Authorization Form - Community Plan

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

Provigil / Nuvigil (Virginia) Prior Authorization Form - Community Plan

Use this paper fax form to submit requests for the following states: Virginia Commonwealth Coordinated Care Plus (CCC Plus)

Ohio Community Plan Prenatal Risk Assessment form incentives | UHCprovider.com

Prenatal Risk Assessment forms (PRAF) are important for the care and referral of patients. They also help ensure that moms receive the best support for a healthy pregnancy. When you fill out the form, we’re notified of the member’s pregnancy, so ...

Provider Forms, Programs and References | UHCprovider.com

Forms and other resources for Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, and Arizona Long Term Care care providers.

Arizona Community Plan Pharmacy Prior Authorization Forms | UHCprovider.com

These paper fax forms are meant to be used in requesting prior authorizations for specific drugs for the state of Arizona Community Plan care providers.

Maryland Community Plan Pharmacy Prior Authorization Forms | UHCprovider.com

These paper fax forms are meant to be used in requesting prior authorizations for specific drugs for the state of Maryland Community Plan care providers.

Texas Community Plan Pharmacy Prior Authorization Forms | UHCprovider.com

These paper fax forms are meant to be used in requesting prior authorizations for specific drugs for the state of Texas Community Plan care providers.

Pennsylvania Community Plan Pharmacy Prior Authorization Forms | UHCprovider.com

These paper fax forms are meant to be used in requesting prior authorizations for specific drugs for the state of Pennsylvania Community Plan care providers.

New Jersey Community Plan Pharmacy Prior Authorization Forms | UHCprovider.com

These paper fax forms are meant to be used in requesting prior authorizations for specific drugs for the state of New Jersey Community Plan care providers.

New York Community Plan Pharmacy Prior Authorization Forms | UHCprovider.com

These paper fax forms are meant to be used in requesting prior authorizations for specific drugs for the state of New York Community Plan care providers.

Rhode Island Community Plan Pharmacy Prior Authorization Forms | UHCprovider.com

These paper fax forms are meant to be used in requesting prior authorizations for specific drugs for the state of Rhode Island Community Plan care providers.