Forms and Documents

Prior Authorization Documents

The following is information and forms available to submit prior authorization requests to PAOTR

Prior Authorization Request Form

Extended Care Prior Authorization Form (SNF, LTAC, REHAB)

Preferred Specialists June 2018 PDF

Preferred SNF List July 2018 Alphabetically PDF

PAR SNF Prior Authorization Notification Letter

PAOTR PA List Effective October 2019

Home Health Request Form PDF

Instructions for Prior Authorization PDF

Provider Forms

These forms are made available for providers to submit initial information or changes to office information

Call Us First Campaign

Attestation Form current 9-19 w Nephropathy #2

Attestation Submission Procedure

RAF Coding Guidelines.pdf

Common Codes with HCC and subcatagories

Provider Demographic Form PDF


Specialists/Provider References

These are tools to assist offices in identifying specialists and specialty providers contracted with UnitedHealthcare.  Please see the UnitedHealthcare website (link below) for a complete list of contracted providers.

Preferred Specialists June 2018 PDF

UHC Provider Lookup PDF

Optum Website for Therapy PDF