Policies, Guidelines & Forms

Prior Authorization (Medical Utilization Management Review) and Notifications:

In order to help you assist patients in a timely and efficient manner; please use the Prior Authorization Request Application. The Prior Authorization application replaces all previous and existing U of U Health Plans Medical Utilization forms.

Updated: If you need to submit Prior Authorization requests via Fax, please use the updated number(s):

Prior Authorization Request Fax Number
Prior Authorization  801-213-1358 
Inpatient Notification, SNF & Rehab  801-213-2132
Behavioral Health & Substance Abuse Treatment     801-213-2132
Appeals 801-587-9985
Pharmacy 801-213-1547

Updated: Please note the current PDF forms suitable for faxing:

Pharmacy/Specialty Review:
  • Retail Pharmacy Forms & Guidelines
  • Commercial Group Plans Medical Pharmacy PA List
  • Individual & Family Plans Medical Pharmacy PA List
  • Healthy U Medicaid Medical Pharmacy PA List
Appeals, Consent, Complaint, Fraud & Abuse, Referral Forms:
General:

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Provider information in this directory is collected from information that we receive from our provider network and updated 5 days per week, excluding weekends, holidays, or interruptions due to upgrades, system maintenance, or unplanned outages. This information is subject to change at any time.