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Get Unitedhealthcare Prior Authorization Fax Request Form 2015-2025
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How to use or fill out the UnitedHealthcare Prior Authorization Fax Request Form online
Filling out the UnitedHealthcare Prior Authorization Fax Request Form is a crucial step in obtaining the necessary authorizations for health services. This guide provides a clear, step-by-step approach to ensure that you complete the form accurately and efficiently.
Follow the steps to complete the authorization request form.
- Press the ‘Get Form’ button to access the form and open it in your preferred editing tool.
- Begin by entering the date at the top of the form. Following this, fill in the contact person's name and their phone and fax numbers. Indicate whether the fax line is HIPAA secure by checking the appropriate box.
- Next, provide the requesting provider's name along with their Tax Identification Number (TIN) and National Provider Identifier (NPI).
- For the member information section, include the member’s name, Member ID/JD number, and date of birth. Indicate whether the member is pregnant, involved in a motor vehicle accident or work-related injury, and if they have other insurance coverage.
- Select the type of request by checking the appropriate box. Specify whether the request is for routine, expedited, inpatient, outpatient, or home services.
- In the servicing provider and facility information section, enter the servicing provider's name, TIN/NPI, address, and fax number. Additionally, indicate the date of service and whether the provider is in-network or out of network.
- Provide clinical information, including diagnoses and associated ICD-10 codes. You will also need to input the required CPT/HCPCS codes and any miscellaneous codes with descriptions. Complete the information regarding the number of visits, the start and end dates, frequency, and the cost of Durable Medical Equipment (DME).
- Lastly, review all entries for completeness and accuracy. You can save the changes, download the completed form, print it, or share it as needed.
Complete your documentation online and ensure timely processing of your authorization requests.
The fax number for UnitedHealthcare prior authorization is available on their official website. They provide separate fax numbers depending on the type of request or plan involved. By utilizing the UnitedHealthcare Prior Authorization Fax Request Form, you can ensure that your request is directed to the right department with all necessary information included.
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