Provider Forms

Listed below are some valuable tools for your convenience.

Participating Provider Referral Form Pre-Certification Form
Non-Participating Provider Referral Form Hospital Pre-Certification Form
Request for Claim Review Appeal Request Form
Medical Record Release Form Global OB Care Notification Form
Prenatal Health Counseling Checklist Behavioral Healthcare Practitioner and PCP Communication Form
Advance Directives Record Form Pre-Certification Form for External Insulin Pump and Supplies
UnitedHealthcare Administrative Guide 2014 (including the River Valley Entities Supplement) Obstetrical Diagnostic Request Form
UnitedHealthcare Administrative Guide - Comparison 2014 to 2013 Continuity of Care Form
UnitedHealthcare Administrative Guide 2013  

If you do not find the form you are looking for on this page, please contact us.