Providers, Please Fill Out and Return the Healthcare Sharing Preauth Form

In order to request and obtain preauthorization, please follow the steps below:

(Requires Adobe Acrobat Reader or compatible web browser.)

1. Click here to download and complete this PDF form
2. Complete form and attach any necessary documentation for the procedure
3. Send the completed form plus any additional documentation to Fax number: (888) 317-9602

Please note that UHSM has a standard turnaround time of five (5) business days on all prior authorization requests. If you require any help with the form, need status of your request, or are unable to determine if a procedure requires preauthorization please contact us at (757) 210-3435.

Prior Authorizations are for professional and institutional services only. All oral medication requests must go through members’ pharmacy benefits. By submitting this prior authorization, you are agreeing to work with UHSM on in-network pricing.