Policies, Guidelines & Forms

What is a Prior Authorization or Pre-authorization?

Certain medical procedures and medications require approval before you will be able to receive treatment. The prior approval process is called pre-authorization, or prior authorization (PA).

Prior authorization allows for a personal review of your treatment within the context of your existing health issues, medications and treatments.

Reasons for Prior Authorization include:

  • Review of treatment options and any related risks to the treatment
  • Manage Costs - Prior Authorization helps ensure that you have insurance coverage for a procedure, treatment or service
  • Avoid excess and waste - utilization management review for inappropriate or unnecessary medical treatments
Procedures, Products and Treatment requiring Prior Authorization
A current list of Medical Services requiring Prior Authorization can be viewed at Medical Prior Authorization List

A current list of Pharmacy Services and Products requiring Prior Authorization for Commercial and Individual plans can be viewed at Medical Pharmacy Prior Authorization List

A current list of Pharmacy Services and Products requiring Prior Authorization for Healthy U Medicaid can be viewed at Healthy U Medical Pharmacy Prior Authorization List

Upcoming Changes to Codes Requiring Prior Authorization
A current list of upcoming medical coding changes requiring prior authorization and their future effective dates is available for viewing: Upcoming Changes to Codes Requiring Prior Authorization

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 EXCEPT for SNF, Acute Rehab and LTAC requests. For SNF, Acute Rehab and LTAC requests, please use the download form: SNF, Acute Rehab and LTAC Prior Authorization.

Medical Services:

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 Use Treatment     801-213-2132
Appeals 801-587-9985
Medical Pharmacy 801-213-1547

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

Coverage Policies:
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.