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 Hospital Admissions – Elective/Emergency (23k)
Acute Hospital Admissions – Continued Stay (23k)
Bariatric Surgery (30k)
Hospice Services (24k)
Long Term Acute Care (LTAC) Admissions (31k)
Lumbar Spine Surgery (25k)
Rehabilitation Facility Admissions (28k)
Skilled Nursing Facility Admissions (31k)


Surgical Procedures - Ambulatory

Bariatric Surgery (30k)
Lumbar Spine Surgery (25k)
Nasal Septoplasty (24k)
Rhinoplasty (24k)
Sinus Endoscopy (25k)
Sleep Apnea Surgery (27k)


Ancillary Services

Home Infusion Services (25k)
Home Health and Hospice Services (24k)
Physical & Occupational Therapy (23k)
Speech Therapy Initial Evaluation (25k)
Speech Therapy Progress Evaluation (23k)


Durable Medical Equipment

Bone Stimulator (24k)
Cochlear Implant (23k)
CPAP Adult – BIPAP – Auto CPAP Child (25k)
Lower Limb Prosthetics (27k)
Myoelectric Prosthetics (24k)
Neuromuscular Stimulators (25k)
TENS Unit (23k)
Wheelchair (Custom/Electric) & Electric Scooter (25k)
Wound Vacs (26k)


Diagnostic Imaging - Ambulatory

MRA of the Head and/or Neck (29k)
MRI of the Brain (24k)
MRI of the Spine – Cervical, Thoracic, Lumbar, Sacral (25k)
PET Scans (27k)


Specialty Infusion Drugs

Specialty Infusion Drugs (24k)

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