Skip to main content

I Am a Provider Provider Portal Brokers

MyDHMP Portal Pay My Premium

Sitewide Navigation

EXPLORE PLANS
MEMBERS
HEALTH SUPPORT
FIND A PROVIDER
RESOURCES
CONTACT US

Sitewide Mobile Navigation

MyDHMP Portal Pay My Premium

EXPLORE PLANS
MEMBERS
FIND A PROVIDER
RESOURCES
GET CARE
CONTACT US
SEARCH

I Am a Provider Provider Portal Brokers

UM Prior Authorization PDF Form

PDF Download

Click links below to download

UM Prior Authorization Request PDF Form - English
UM Prior Authorization Request PDF Form - Spanish

Home

MyDHMP Member Portal

Find a Provider

Member Newsletter

Wellness Blog

Resources

Contact Us

Member FAQs

About Us

Annual Report

Member Advisory Council

Rights & Responsibilities

Quality Improvement

Statement About Incentives

Third Party Apps

DHMP Interoperability APIs

Non-Discrimination Notice

Accessibility Statement

Compliance Program

Fraud, Waste & Abuse

Payment Integrity

Health Insurance Glossary

Language Assistance

हिन्दी

Terms and Conditions of Use

Social Media Terms of Use

Adobe Acrobat is required to read PDFs

Microsoft is required to read Excel

We use cookies to make interactions with our website easy and meaningful. By continuing to use this site, you are giving us your consent. Learn how cookies are used on our site.
Accept Terms