Utilization Management Fax Forms

No more phone calls, wait times or delays!
Our new Fax and Fax-Back procedures streamline the precertification/certification process for health care providers. The UM Fax forms request information pertinent only to the current admission or service requested, and to relevant discharge planning needs. The fax number for HealthLink’s Medical Management Department is 800-510-2162.

Inpatient Services

Acute Inpatient Rehabilitation Facility Admissions (26k)
Continued Stay Recertification Pre-Review (22k)
Inpatient Medical Pre-Review (23k)


Surgical Procedures - Ambulatory

Nasal Septoplasty (22k)
Rhinoplasty (22k)


Ancillary Services

Home Health Services Home Hospice (22k)
Home Infusion Services (23k)
Occupational & Physical Therapy (22k)
Speech Therapy (23k)


Durable Medical Equipment

Bone Stimulators (23k)
Cochlear Implant (22k)
CPAP-BiPap-Adult and Child (23k)
Electric Scooters & Custom Wheelchairs (23k)
Limb Prosthetics (23k)
Myoelectric Prosthetics (23k)
TENS Unit (21k)


Diagnostic Imaging - Ambulatory

MRA of the Head and/or Neck (27k)
MRI of the Brain (23k)
MRI of Spine - Cervical, Thoracic, Lumbar and Sacral (25k)
PET Scans (23k)

Download Adobe Acrobat Reader to view the various portable document format (PDF) documents available throughout the HealthLink website.