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UPHP PRIOR AUTHORIZATION PA REQUEST FORM FAX to 906 225 9269

UPHP PRIOR AUTHORIZATION PA REQUEST FORM FAX to 906 225 9269

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Hello. Do you submit prior authorization  requests for certain hospital outpatient   department procedures? Did you know that the prior  authorization affirmative decision and unique   tracking number [UTN] are actually valid for  120 days from the date of your decision letter?   Recently we've received resubmissions of  affirmed prior authorization requests,   that contain the note stating  that the surgery date has changed.   If your new surgery date is within that 120 days  from the date of your decision letter you do not   need to resubmit an additional prior authorization  request. The decision letter date counts as the   first day of the 120 days. For example, if your  prior authorization is affirmed on January 1st,   2021, the prior authorization will be valid  for dates of service through April 30th,   2021. If there are changes to the facility  where the service will be performed,   or the CPT or HCPCS code submitted, this would  warrant

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