Upmc Health Plan Prior Auth Form

All downloadable forms are pdf files. Before you get started, in addition to your insurance card, you will need the following information. This information can be obtained by contacting your prescribing physician. Oct 1, 2024 · please follow these steps to submit prescription drug determination forms to us. The forms linked below can be used to request prior authorization, coverage determination and.

To submit a request online, please visit upmc's promptpa portal. To submit a request via fax,. Please complete all sections of this form and include details of past relevant medical treatment, which substantiates the need for an exception to using formulary alternatives, i. e. Healthhelp is working with upmc health plan to administer a consultative prior authorization program for advanced radiology/imaging, cardiology, sleep, and musculoskeletal services. Upmc community healthchoices offers prescription drug coverage for participants.