Provider Information
You don't have time to spare: that's why we put all the documents you need in one place.
Use the navigation items on the left to find what you're looking for fast.
Forms
Prior Authorization Fax Form (PDF 89.89 KB)
Sterilization Consent Form (PDF 20.18 KB)
PCP Change Fax Form (PDF 115.01 KB)
Provider Manual
Physician, Health Care Professional,Facility and Ancillary Provider Manual (PDF 2.74 MB)
Formulary
Formulary - State of Washington (PDF 782.8 KB)
Medical Injectables
To review the clinical criteria/guidelines used to conduct medical necessity reviews, please use this link: https://www.unitedhealthcareonline.com/b2c/CmaAction.do?channelId=ca174ccb4726b010VgnVCM100000c520720a____
Access to Behavioral Health Services
Members have statewide access for routine behavioral health services. Out-of-state behavioral services are limited to specific emergency services. Optum Behavioral Health works with the Washington State Regional Support Networks (RSNs) to ensure members receive the appropriate level of care. The RSNs use state-mandated criteria to evaluate and direct members.
Providers may contact Optum Behavioral Health at 1-855-802-7089 for information on referring patients for behavioral health services.
To find a behavioral health provider, members can call Member Services, at 1-877-542-8997 (TTY: 711).
Integrity of Claims, Reports, and Representations to the Government
UnitedHealth Group requires compliance with the requirements of federal and state laws that prohibit the submission of false claims in connection with federal health care programs, including Medicare and Medicaid. Click here (PDF 34.75 KB) to download our policy.
Disclaimer
If UHG Medical Policies conflict with provisions of a State contract or with state or federal law, the contractual / statutory / regulatory provisions shall prevail.
To see updated policy changes, select the Bulletin section at left.