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

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

Prior Authorization and Notification | UHCprovider.com

In this section you will find the tools and resources you need to help manage your practice’s prior authorization and notification requirements, with program specific information available for Cardiology, Oncology, Radiology, Clinical Pharmacy and...

Advance Notification and Plan Requirement Resources | UHCprovider.com

Advance notification is the first step in UnitedHealthcare’s process to determine coverage for a member. Certain services and plans require advance notification so we can determine if they are medically necessary and covered by the member’s plan.

Texas Standard Prior Authorization Request Form for Prescription Drug Benefits - UnitedHealthcare Community Plan of Texas

Beginning September 1, 2015, health benefit plan issuers must accept the Texas Standardized Prior Authorization Request Form for Prescription Drug Benefits if the plan requires prior authorization of a prescription drug or device. In addition to ...

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.

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.

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.

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.

Washington 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 Washington 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.

Hawaii 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 Hawaii 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.

Virginia 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 Virginia Community Plan care providers.

Virginia 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 Virginia Community Plan care providers.

Colorado 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 Colorado Community Plan care providers.