UnitedHealthcare Community Plan
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Please select the state where you practice.

You'll find all forms we currently use in the following list.

We're currently reviewing all forms in an effort to make it easier and simpler to work with us, so check back frequently to see what's changed.

 

Long-Acting Opiates Prior Authorization Form (PDF 564.41 KB) (PDF 564 KB)

FAQ for Sleep Test Optimization Program (PDF 126.02 KB) (PDF 126.02 KB)

Group Disclosure of Ownership and Control of Interest Form click here (PDF 519.75 KB) (PDF 519.75 KB) for PDF version.

Individual Disclosure of Ownership and Control of Interest Form click here (PDF 427.75 KB) (PDF 427.75 KB) for PDF version.

Provider Disclosure of Ownership and Control Interest Statement - FAQ (PDF 256.6 KB) (PDF 256.6 KB)

Prior Authorization Fax Request Form (PDF 164.77 KB) (PDF 164.77 KB)

Health Education Request Form (Presentation) (PDF 226.12 KB) (PDF 226.12 KB)

Health Ed Request Form (Print Material) (PDF 220.78 KB) (PDF 220.78 KB)

Botulinum Toxins Prior Authorization Form (PDF 507.57 KB) (PDF 507.57 KB)

HP Acthar Gel Prior Authorization Form (PDF 224.78 KB) (PDF 224.78 KB)

Immune Globulin Prior Authorization Form (PDF 231.78 KB) (PDF 231.78 KB)

Makena Prior Authorization (PDF 228.15 KB) (PDF 228.15 KB)

Sleep Study FAQ (PDF 144.85 KB) (PDF 144.85 KB)

Sleep Study Worksheet (PDF 192.95 KB) (PDF 192.95 KB)