There are two options for submitting a UM Prior Authorization Request

Option 1: Submit using the UM Prior Authorization Request Online Form 

Option 2: 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