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Get UnitedHealthcare PCA13351 2014-2024

Form. Please fax the requested information to: 800-628-0654 promptly, as an accurate coverage decision cannot be made without this information. If you have any questions, or if this request is related to an emergent request for surgery, please call 877-842-3210. Thank you. To: UnitedHealthcare From: Fax:1-800-628-0654 Fax: Service Reference Number (Srn): Phone: Pages (Including Cover): Notification needs to be completed and Service Reference Number obtained prior to faxing this form. Cer.

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