Provider forms
Health care professionals can access forms for UnitedHealthcare plans, including commercial, Medicaid, Medicare and Exchange plans in one convenient location.
Easily access and download all UnitedHealthcare provider-forms in one convenient location.
Save time – Go digital
The UnitedHealthcare Provider Portal allows you to submit referrals, prior authorizations, claims, claim reconsideration and appeals, demographic changes and more.
Select plan type
Commercial
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If your select says “Complete in portal”, you can skip the PDF form and complete the action online in the UnitedHealthcare Provider Portal.
Claims and payments
- Claims Overpayment Refund Form PDF
- Corrected Claim and Claim Reconsideration Request Form PDF | Complete in portal
Exception Requests
- Colorado Standard Exemption Form for Contraceptive Products PDF | Complete in portal
- New York Contraceptive Exception Request Form PDF | Complete in portal
Other
- Confidential Exchange of Information Form PDF
- Commercial Designation of Authorized Representative Form PDF | Complete in portal
- Option Care Health Medication Prescriber Order Form PDF
- Skilled Nursing Facilities Clinical and Therapy Request Form PDF
Our network
- Demographic Change Form PDF | Complete in portal
Prior authorization
Sign in to the UnitedHealthcare Provider Portal to complete prior authorizations online.
- Arizona Health Care Services Prior Authorization Form PDF | Complete in portal
- Arizona Prior Authorization Medications DME Medical Devices Form PDF | Complete in portal
- California Prescription Prior Authorization Form PDF | Complete in portal
- Colorado Prescription Prior Authorization Form PDF | Complete in portal
- Illinois Prescription Drugs Prior Authorization Request Form PDF | Complete in portal
- Indiana Prescription Prior Authorization Form PDF | Complete in portal
- Louisiana Prescription Prior Authorization Form PDF | Complete in portal
- Massachusetts Cardiac Imaging Prior Authorization Request Form PDF | Complete in portal
- Massachusetts Chemotherapy Supportive Care Prior Authorization Request Form PDF | Complete in portal
- Massachusetts Hepatitis Medication Prior Authorization Request Form PDF | Complete in portal
- Massachusetts Non-OB Ultrasound Request Form PDF | Complete in portal
- Massachusetts PET CT Request Form PDF | Complete in portal
- Massachusetts Prescription Prior Authorization Form PDF
- Massachusetts Synagis® Prior Authorization Request Form PDF | Complete in portal
- Michigan Prescription Drug Prior Authorization Form FIS 2288 PDF
- Network Prior Authorization Gap Exception Request Form PDF | Complete in portal
- Nevada Cancer Stage 3 or 4 Step Therapy Protocol Prior Authorization Exception Form PDF | Complete in portal
- Nevada Medical Standard Prior Authorization Form PDF | Complete in portal
- New Hampshire Prescription Prior Authorization Form PDF
- New Mexico Prior Authorization Form PDF | Complete in portal
- New York Prior Authorization Predetermination Form PDF
- Oregon Commercial Plan Prescription Prior Authorization Form PDF | Complete in portal
- Texas Commercial Prior Authorization Form PDF
- Texas Surest Prescription Prior Authorization Form PDF | Complete in portal
- West Virginia Pre-Determination Form Complete in portal
Medicare Advantage
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- Corrected Claim and Claim Reconsideration Request Form
- Demographic Change Form
- Medicare Direct PFFS Uncollectible Bad Debt Submittal Form
- Skilled Nursing Facilities Clinical and Therapy Request Form
To learn more about Medicare Part D prescription drug coverage or to access related forms, review the materials available on the Plan Information and Forms page of UHC.com/medicare.
