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

PDF Download

Click links below to download