Claims and payments
- Claims Overpayment Refund Form PDF
- Corrected Claim and Claim Reconsideration Request Form Complete online | PDF
- New Jersey DOBI Healthcare Provider Application (Commercial) PDF
- New Jersey DOBI Healthcare Provider Application (Oxford) PDF
Exception Requests
Other
- Colorado Serious Mental Illness Step Therapy Exception Form PDF
- Confidential Exchange of Information Form PDF
- Commercial Designation of Authorized Representative Form Complete online | PDF
- New York Empire Plan Predetermination Request Form PDF
- Option Care Health Medication Prescriber Order Form PDF
- Skilled Nursing Facilities Clinical and Therapy Request Form PDF
Our network
- Provider Termination for Cause Appeal Form PDF
- Provider Termination Without Cause Appeal Form PDF
Prior authorization
Sign in to the UnitedHealthcare Provider Portal to complete prior authorizations online.
- Arizona Health Care Services Prior Authorization Form Complete online | PDF
- Arizona Prior Authorization Medications DME Medical Devices Form Complete online | PDF
- California Prescription Drugs Prior Authorization Form Complete online | PDF
- Colorado Prescription Prior Authorization Form Complete online | PDF
- District of Columbia Transition of Prior Authorization form for Surest plans PDF
- District of Columbia Transition of Prior Authorization form for UHC plans PDF
- Empire Plan Predetermination Form PDF
- Georgia Transition of Prior Authorization form for Surest plans PDF
- Georgia Transition of Prior Authorization form for UHC plans PDF
- Illinois Prescription Drugs Prior Authorization Request Form Complete online | PDF
- Indiana Prescription Prior Authorization Form Complete online
- Indiana Transition of Prior Authorization form for UHC plans | PDF
- Indiana Transition of Prior Authorization form for Surest plans | PDF
- Louisiana Prescription Prior Authorization Form Complete online | PDF
- Massachusetts Cardiac Imaging Prior Authorization Request Form Complete online | PDF
- Massachusetts Chemotherapy Supportive Care Prior Authorization Request Form Complete online | PDF
- Massachusetts Hepatitis Medication Prior Authorization Request Form Complete online | PDF
- Massachusetts Non-OB Ultrasound Request Form Complete online | PDF
- Massachusetts PET CT Request Form Complete online | PDF |
- Massachusetts Prescription Prior Authorization Form PDF
- Massachusetts Synagis® Prior Authorization Request Form Complete online | PDF
- Michigan Prescription Drug Prior Authorization Form FIS 2288 PDF
- Minnesota Transition of Prior Authorization form for Surest plans PDF
- Minnesota Transition of Prior Authorization form for UHC plans PDF
- Mississippi Transition of Prior Authorization form for Surest plans PDF
- Mississippi Transition of Prior Authorization form for UHC plans PDF
- Network Prior Authorization Gap Exception Request Form Complete online | PDF
- Nevada Cancer Stage 3 or 4 Step Therapy Protocol Prior Authorization Exception Form Complete online | PDF
- New Hampshire Prescription Prior Authorization Form PDF
- New Jersey Transition of Prior Authorization form for UHC plans PDF
- New Mexico Prescription Prior Authorization Form PDF
- Oklahoma Transition of Prior Authorization form for Surest plans PDF
- Oklahoma Transition of Prior Authorization form for UHC plans PDF
- Oregon Commercial Plan Prescription Prior Authorization Form Complete online | PDF
- Tennessee Transition of Prior Authorization form for Surest plans PDF
- Tennessee Transition of Prior Authorization form for UHC plans PDF
- Texas Commercial Prior Authorization Form PDF
- Washington Transition of Prior Authorization form for UHC plans PDF
- West Virginia Pre-Determination Form Complete online
- West Virginia Transition of Prior Authorization form for Surest plans PDF
- West Virginia Transition of Prior Authorization form for UHC plans PDF
- Wyoming Transition of Prior Authorization form for UHC plans PDF