Get Unicare Prior Authorization

Filling out the Unicare Prior Authorization form online is an essential step in obtaining the necessary approval for various medical services. This guide provides a clear and user-friendly approach to ensure that you complete the form accurately and efficiently.

Follow the steps to fill out the Unicare Prior Authorization form online.

1. Click 'Get Form' button to acquire the Unicare Prior Authorization form and open it in your preferred editing tool.
2. Ensure all sections of the form are filled out completely, as incomplete submissions may be returned unprocessed.
3. Enter the health plan name and fax number at the top of the form to specify the recipient of the authorization request.
4. Provide the date the form is completed and faxed to track submission timelines.
5. Select the service type requiring authorization by checking all applicable boxes, such as outpatient services, surgery, or home health.
6. Fill out the provider information section, ensuring to include the requesting and servicing provider’s names, National Provider Identifier (NPI) numbers, and contact details.
7. Complete the member information section with the patient's name, date of birth, health insurance ID, and address.
8. In the diagnosis and planned procedure information section, provide the principal diagnosis description, including ICD-9 codes, and the planned procedure details with the relevant CPT/HCPCS codes.
9. Clearly indicate the service start date and service end date to outline the duration of requested services.
10. Review all entries for accuracy before submission. After verifying the information, you can save changes, download, print, or share the form as needed.

Complete the Unicare Prior Authorization form online today to ensure timely processing of your request.