Provider Forms and References
See the provider forms and references below.
- Group Disclosure of Ownership and Control of Interest Form - Online Version
- Individual Disclosure of Ownership and Control of Interest Form - Online Version
- Obstetric OB Risk Assessment Form
- Prior Authorization Forms
- Resident Admission-Discharge Form
- Synagis Enrollment Form
- UnitedHealthcare Attention-Deficit/Hyperactivity Disorder (ADHD) Toolkit
Submit a Pre-Service Appeal and or Grievance for a Medicaid Member