Prior Authorization Form
Our goal is to provide the most appropriate and timely care for our mutual
patients. To this end, "Expedited" is defined as: Medical services that are
needed in a timely or expedited manner that would subject the member to adverse
health consequences without the care or treatment requested. University of
Utah Health Plans reserves the right to classify expedited requests as standard
requests when this definition is not met.
For SNF, Acute Rehab and LTAC requests, please download and use the SNF, Acute Rehab and LTAC Prior Authorization form