UM 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
Acute Hospital Admissions - Continued Stay
Bariatric Surgery
Cervical Spine Surgery Precertification Review
Hospice Services
Long Term Acute Care (LTAC) Admissions
Lumbar Spine Surgery
Rehabilitation Facility Admissions
Skilled Nursing Facility Admissions

Surgical Procedures - Ambulatory

Bariatric Surgery
Cervical Spine Surgery Precertification Review
Cochlear Implant
Lumbar Spine Surgery
Mandibular/Maxillary - Orthognathic Surgery
Nasal Septoplasty
Orthopedic Surgery - Repair of Osteochondral Defects
Sinus Endoscopy
Sleep Apnea Surgery

Ancillary Services

Home Infusion Services
Home Health and Hospice Services
Physical & Occupational Therapy
Speech Therapy Initial Evaluation
Speech Therapy Progress Evaluation

Durable Medical Equipment

Bone Stimulator
CPAP Adult ? BIPAP ? Auto CPAP Child
Lower Limb Prosthetics
Myoelectric Prosthetics
Neuromuscular Stimulators
Wheelchair (Custom/Electric) & Electric Scooter
Wound Vacs

Diagnostic Imaging - Ambulatory

MRA of the Head and/or Neck
MRI of the Brain
MRI of the Spine ? Cervical, Thoracic, Lumbar, Sacral
PET Scans

Specialty Infusion Drugs

Specialty Infusion Drugs