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.

Pre-Review Forms

Continued Stay/Recertification (28k)
Home Health Care/Hospice Pre-Review (20k)
Home Infusion Pre-Review (30k)
Initial Precertification Review (28k)
Inpatient Medical Pre-Review (22k)
Inpatient Rehab Admission (22k)
MRI Pre-Review (22k)
Physical/Occupational Therapy Pre-Review (29k)


Durable Medical Equipment

Speech Therapy Pre-Review (27k)
DME-Custom Wheelchair/Electric Scooter Pre-Review (23k)
DME-General Pre-Review (21k)
DME-Stimulators Pre-Review (21k)

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