Link: https://www.upmchealthplan.com/providers/medical/resources/forms/pharmacy-pa.aspx
Description: WebProviders may submit prior authorization requests to UPMC Health Plan online or by fax. To submit a request online, please visit UPMC's PromptPA Portal. To submit a request via fax, please select the appropriate form below. These forms serve all UPMC Health Plan products unless specified otherwise.
DA: 7 PA: 20 MOZ Rank: 70
Link: https://www.upmchealthplan.com/providers/medical/resources/forms/medical-pa.aspx
Description: WebMedical Prior Authorization and Physician Forms: UPMC Health Plan requires a prior authorization request for specific procedures or treatments to determine whether coverage of a request will be approved or denied.
DA: 70 PA: 21 MOZ Rank: 85
Link: https://www.upmchealthplan.com/providers/medical/resources/forms/
Description: WebVision. HCBS. MEDICAL PROVIDER FORMS. Get fast, easy access to downloadable forms. Medical Providers. Medical Prior Authorization. Download medical prior authorization forms here. Find Medical Prior Authorization Forms. Pharmacy Prior Authorization. Download pharmacy prior authorization forms here. Find Pharmacy Prior Authorization Forms.
DA: 9 PA: 16 MOZ Rank: 76
Link: https://www.upmchealthplan.com/medicare/documents-and-forms/
Description: WebThe forms linked below can be used to request prior authorization, coverage determination and redetermination, or an exception for prescription drugs. Select and open the appropriate form:
DA: 7 PA: 62 MOZ Rank: 58
Link: https://www.upmchealthplan.com/providers/medical/
Description: WebMedical Prior Authorization and Physician Forms. Pharmacy Prior Authorization. Notice of Medicare Non-Coverage (NOMNC) Provider Disclosure of Ownership and Control. Prior Authorization List (Excel) Guidelines. Clinical Practice Guidelines. Telehealth Guidelines.
DA: 75 PA: 22 MOZ Rank: 50
Link: https://www.upmchealthplan.com/docs/providers/PApdf/Stimulants.pdf
Description: WebStimulants. Prior Authorization Form. IF THIS IS AN URGENT REQUEST, Please Call UPMC Health Plan Pharmacy Services. Otherwise please return completed form to: UPMC HEALTH PLAN PHARMACY SERVICES PHONE 800-396-4139 FAX 412-454-7722. Stimulant PA form. All PA forms available at www.upmchealthplan.com/providers/pa_forms.html. December 2012.
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Link: https://upmc.promptpa.com/
Description: WebNew Prior Authorization. Check Status. Member. Prescriber.
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Link: https://www.upmc.com/patients-visitors/patient-info/forms
Description: WebUPMC Forms. 2019-2020 Parent-Guardian Release Form – Family Health Center Free Inhaler Program. Consent for Treatment, Payment and Health Care Operations. Personal Representative Designation. Medical Consent Evaluation. Authorization for Release of Protected Health Information. MyUPMC Pediatric Proxy Request.
DA: 47 PA: 13 MOZ Rank: 15
Link: https://chc.upmchealthplan.com/en/members/documents-resources/
Description: WebMember Authorization to Use/Disclose PHI. Personal Representative Designation Form. 2024 Summary of Benefits. 2024 Participant Handbook. Prescription Drug Search. UPMC Community HealthChoices Pharmacy Formulary (Non-PDL) (PDF) UPMC Community HealthChoices Pharmacy Formulary (Non-PDL) (JSON) Pharmacy Directory. Provider …
DA: 92 PA: 41 MOZ Rank: 40
Link: https://www.upmchealthplan.com/docs/providers/PApdf/Lupron.pdf
Description: WebPrior Authorization Form. IF THIS IS AN URGENT REQUEST, Please Call UPMC Health Plan Pharmacy Services. Otherwise please return completed form to: UPMC HEALTH PLAN PHARMACY SERVICES PHONE 800-979-UPMC (8762) FAX 412-454-7722. LHRH Agent PA form. All PA forms available at www.upmchealthplan.com/providers/pa_forms.html. …
DA: 53 PA: 75 MOZ Rank: 34
