Prior authorization is required for some services and medications. A current list of prior authorization services, medications and forms can be found below.
Last Published 06.03.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care
Last Published 04.16.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care
Last Published 01.11.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 01.31.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 02.04.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 09.25.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 01.25.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care
Last Published 03.05.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care
Last Published 04.16.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 09.23.2019
Use this paper fax form to submit requests for the following state plans: Arizona, Florida Healthy Kids, Hawaii, Maryland, New Jersey, New York, New York EPP, Ohio, Pennsylvania, Rhode Island
Last Published 06.05.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 05.01.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 09.17.2018
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 04.18.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care
Last Published 01.28.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 02.06.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 03.25.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 01.28.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 09.25.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare Rite Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 06.05.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 04.17.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 03.25.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 04.16.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 02.06.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 01.29.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 09.27.2018
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Florida Community Plan M*Plus (MMA), Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 06.03.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care
Last Published 06.10.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 01.28.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care
Last Published 12.31.2018
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 09.17.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care
Last Published 02.04.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 04.05.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion, Washington UnitedHealthcare Community Plan
Last Published 04.24.2018
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care
Last Published 02.06.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 04.16.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care
Last Published 07.31.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 07.25.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Ohio UnitedHealthcare Community Plan
Last Published 01.30.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 03.11.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 01.25.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care
Last Published 06.10.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids
Last Published 09.26.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare Rite Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 09.30.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare Rite Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 01.28.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 09.30.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care
Last Published 09.30.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program,
Last Published 01.28.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 02.05.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 09.24.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care
Last Published 04.16.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 10.04.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care
Last Published 11.01.2018
Use this paper fax form to submit requests for the following state plans: Arizona, Florida Healthy Kids, Hawaii, Maryland, New Jersey, New York, Ohio, Rhode Island
Last Published 01.28.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 01.30.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 02.05.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 02.05.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 01.23.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 03.25.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 03.05.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care
Last Published 05.02.2018
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care
Last Published 10.01.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 02.06.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 11.02.2018
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion, Washington UnitedHealthcare Community Plan
Last Published 02.05.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 01.30.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 12.26.2018
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, UnitedHealthcare Connected® for MyCare Ohio, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 03.26.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 03.25.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care
Last Published 01.28.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 04.05.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 12.27.2018
Prior Authorizations form for Inhaled Corticosteroids/Long-Acting Beta Agonist Combinations - Advair, Dulera, Symbicort, Breo Ellipta and AirDuo. Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care.
Last Published 04.16.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care
Last Published 09.25.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare Rite Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 06.11.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 02.05.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 01.28.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 04.16.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 08.12.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care
Last Published 07.08.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care
Last Published 01.23.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 06.10.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 02.05.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 02.04.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 03.11.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 03.05.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care
Last Published 09.26.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 04.02.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 02.04.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 09.23.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare Rite Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 02.06.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids
Last Published 06.05.2018
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care
Last Published 08.12.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, FLorida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare Rite Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 03.18.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 09.24.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare Rite Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 03.11.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids
Last Published 01.28.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 09.23.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare Rite Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 02.06.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 01.28.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 01.02.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care
Last Published 09.16.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care
Last Published 09.30.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care
Last Published 03.25.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 09.30.2019
se this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice,
Last Published 10.04.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care
Last Published 01.28.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care
Last Published 04.16.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 02.06.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 02.04.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 12.31.2018
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 04.05.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion, Washington UnitedHealthcare Community Plan
Last Published 03.19.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 04.27.2018
Use this paper fax form to submit requests for the following states: Arizona
Last Published 03.11.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 02.06.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 02.06.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 01.07.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 01.30.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 10.04.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 01.23.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 11.06.2018
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids
Last Published 04.23.2018
Use this paper fax form to submit requests for the following states: Arizona
Last Published 10.10.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care
Last Published 02.06.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 10.09.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care
Last Published 01.28.2019
Use this paper fax form to submit requests for the following states: Hawaii, Maryland and New York
Last Published 10.08.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care
Last Published 02.04.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 04.15.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care
Last Published 12.31.2018
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 11.06.2018
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Essential Plan, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion, Washington UnitedHealthcare Community Plan
Last Published 02.05.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 10.08.2019
Please complete this entire form for UnitedHealthcare Community Plan members needing a Synagis prescription and fax it to the UnitedHealthcare Community Plan Prior Authorization Department.
Last Published 09.27.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 02.05.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 02.04.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare Rite Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 05.02.2018
Use this paper fax form to submit requests for the following states: Arizona
Last Published 09.30.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare Rite Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 02.04.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 02.05.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 03.18.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 01.28.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 03.18.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 01.28.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 05.06.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care
Last Published 01.07.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 01.03.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 03.19.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 05.02.2018
Use this paper fax form to submit requests for the following states: Arizona
Last Published 01.31.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 01.29.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care
Last Published 10.04.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 11.07.2018
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion, Washington UnitedHealthcare Community Plan
Last Published 03.18.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 02.04.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 03.18.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 10.10.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care
Last Published 01.30.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 03.07.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 04.16.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 04.22.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 03.18.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 10.23.2018
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 07.09.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 02.05.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 02.01.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 01.23.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 03.18.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
Last Published 02.19.2019
Use this paper fax form to submit requests for the following state plans: Arizona AHCCCS/Medicaid, Arizona Children's Rehabilitative Services (CRS) Program, Arizona Developmentally Disabled Program, Arizona Long Term Care, Florida Healthy Kids, Hawaii UnitedHealthcare Community Plan QUEST Integration Program, Maryland HealthChoice, New Jersey FamilyCare, New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program, New York Child Health Plus, New York Essential Plan, New York Community Plan MLTSS, New York UnitedHealthcare Community Plan, New York UnitedHealthcare Wellness4Me, Ohio UnitedHealthcare Community Plan, Pennsylvania UnitedHealthcare Community Plan for Families, Pennsylvania UnitedHealthcare Community Plan for Kids, Rhode Island Children with Special Health Care Needs, Rhode Island UnitedHealthcare RIte Care, Rhode Island UnitedHealthcare Rhody Health Partners, Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion