Prior Authorization (Medical Utilization Management Review) & 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 download and use the SNF, Acute Rehab and LTAC Prior Authorization form.
Prior Authorization requests via Fax
Updated: If you need to submit Prior Authorization requests via Fax, please use the updated number(s)
|Prior Authorization Request||Fax Number|
|Inpatient Notification, SNF & Rehab||801-213-2132|
|Behavioral Health & Substance Use Treatment||801-213-2132|
Updated: Please note the current PDF forms are suitable for faxing
Medical Documentation Submission Form
Along with the missing documentation, please use the form for MDOC claim denials.
Complete the form online, upload the required documentation files, and click “Submit,” instead of faxing the form.