Submit a UM Prior Authorization Request Online or by Fax
To Submit Online
UM Prior Authorization Request Online Form
To Submit by Fax
Complete and fax a UM Prior Authorization Request PDF Form below
- Fax Inpatient requests to: 303-602-2127
- Fax Outpatient requests to: 303-602-2128
- Fax Urgent/Expedited requests to: 303-602-2160