Policies, Guidelines & Forms

Certain medical procedures and medications require approval before you will be able to receive treatment. The prior approval process is called pre-authorization, or prior authorization (PA).

Prior authorization allows for a personal review of your treatment within the context of your existing health issues, medications and treatments.

Reasons for Prior Authorization include:

• Review of treatment options and any related risks to the treatment
• Manage Costs - Prior Authorization helps ensure that you have insurance coverage for a procedure, treatment or service
• Avoid excess and waste - utilization management review for inappropriate or unnecessary medical treatments

Procedures, Products and Treatment requiring Prior Authorization

• A current list of Medical Services requiring Prior Authorization can be viewed on the Medical Services requiring Prior Authorization

Upcoming Changes to Codes Requiring Prior Authorization

No changes are currently scheduled for the next 60 days.

Prior Authorization (Medical Utilization Management Review) & Notifications

In order to help you assist patients in a timely and efficient manner; please use the Prior Authorization Request Application. The Prior Authorization application replaces all previous and existing U of U Health Plans Medical Utilization forms EXCEPT for SNF, Acute Rehab and LTAC requests . For SNF, Acute Rehab and LTAC requests, please download and use the SNF, Acute Rehab and LTAC Prior Authorization form.

Prior Authorization requests via Fax

Updated: If you need to submit Prior Authorization requests via Fax, please use the updated number(s)

Updated: Please note the current PDF forms are suitable for faxing

• Prior Authorization
• Behavioral Health & Substance Treatment
• Medicaid Integration Residential Treatment
• Home Health
• Hospice
• SNF, Acute Rehab and LTAC

Medical Documentation Submission Form

Along with the missing documentation, please use the form for MDOC claim denials.
Complete the form online, upload the required documentation files, and click “Submit,” instead of faxing the form.