Clinical and Therapy Request Form for UnitedHealthcare Clinical Services Medical Management

UnitedHealthcare Clinical Services and Therapy Request Form

UnitedHealthcare Community Plan Pharmacy prior authorization guidelines for AZ - Preferred Non-Solid Dosage Forms

UnitedHealthcare Community Plan Pharmacy prior authorization guidelines for CA - Preferred Non-Solid Dosage Forms

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

Prior Authorization Fax Form

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

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

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

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

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

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

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

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

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

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