Please select the state where you practice.

Provider Forms 

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.

Bus Pass Exemption Forms

Bus Exemption Form - Brentwood  (PDF 37.89 KB)
Bus Exemption Form - Chattanooga  (PDF 36.77 KB)
Bus Exemption Form - Kingsport  (PDF 36.77 KB)
Bus Exemption Form - Knoxville  (PDF 36.75 KB)
Bus Exemption Form - Memphis (PDF 36.74 KB)


CHOICES (Long Term Care)

Prior Authorization Fax Form
Provider Application  (PDF 93.23 KB)
Provider Change Form (PDF 112.29 KB)
UnitedHealthcare Community Plan (TennCare) Prior Authorization Fax Form


UnitedHealthcare Dual Complete (Special Needs Product (SNP)

DSNP Outpatient Observation Notification Form (PDF 35.73 KB)