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.
EPSDT / Healthchek
Use these forms for appointments related to Early Periodic Screening, Diagnosis, and Treatment (EPSDT) / Healthchek.
Prior Authorization Forms
Gaucher's Disease Enzyme Therapy Prior Authorization Form (PDF 230.94 KB)
Prior Authorization Fax Request (PDF 50.26 KB)
Quick Reference Guides
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____