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  • Upmc Prior Auth Form

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Prior Authorization Form IF THIS IS AN URGENT REQUEST, please call UPMC Health Plan Pharmacy Services. Otherwise, return completed form to: UPMC HEALTH PLAN PHARMACY SERVICES PHONE 18003964139.

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All completed authorization forms can be faxed to: 717-782-3671 OR sent to: UPMC in Central Pa. You can then give the completed authorization form to the individual or organization to whom you wish to give access to.

UPMC Health Plan accepts electronic claims in data file transmissions. Providers who have existing relationships with clearinghouses such as WebMD (UPMC Health Plan Payer ID: 23281), NDC, and HDS can continue to transmit claims in the format produced by their billing software.

Prior authorization is not required for emergency or urgent care. Out-of-network physicians, facilities and other health care providers must request prior authorization for all procedures and services, excluding emergent or urgent care, as identified below.

Payer Name: Vantage Health Plan, Inc. Payer ID: 72128|Professional (CMS1500)/Institutional (UB04)[Hospitals]

If you require a prior authorization for a medication not listed here, please contact UPMC Health Plan Pharmacy Services at 1-800-979-UPMC (8762). If you are unable to locate a specific drug on our formulary, you can also select Non-Formulary Medications, then complete and submit that prior authorization form.

Providers treating UPMC Health Plan members will be required to submit prior authorization requests for advanced radiology/imaging, cardiology, sleep, and musculoskeletal services.

Payer Name: South Central Preferred.

Just click to connect. You can also visit the Contact UPMC page or call 412-647-8762 (UPMC) or 1-800-533-8762 (UPMC). If this is an urgent medical matter, please call 911 or go to the nearest ER for treatment.

clearinghouses. Update the clearinghouse with the Tufts Health Public Plans payer ID number: 04298. ABILITY® — for questions about setup and connectivity, visit ABILITY's website or call 888-499-5465.

CLAIM.MD | Payer Information | UPMC Health Plan.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232