UM Prior Authorization Request Form

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