There are two options for submitting a UM Prior Authorization Request.


Option 1:

Submit here, 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