01. Edit your snf request online
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Snf authorization form 2026
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02. Sign it in a few clicks
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Send snf request form via email, link, or fax. You can also download it, export it or print it out.
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- Click ‘Get Form’ to open the SNF authorization form in the editor.
- Begin by entering the patient information. Fill in the patient's name, Member ID, and date of birth in the designated fields.
- Next, provide your details as the person filling out the form. Include your name and phone number, along with the requesting provider's name and fax number.
- Indicate the hospital from which the request is being made and specify the anticipated discharge date. Also, mention where the patient will be transferred (SNF, LTAC, etc.).
- In the skilled need section, check all applicable therapies required for the patient such as physical therapy or wound care.
- Finally, attach any relevant clinical information that supports this request. This may include progress notes and therapy evaluations.
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Please fill out the form below to request verification and authorization before sending any sensitive information to third parties.
USE THIS FORM TO REQUEST AUTHORIZATION (OR INITIAL PRECERTIFICATION) FOR SKILLED NURSING, LONG-TERM CARE HOSPITAL, OR REHABILITATION HOSPITAL SERVICES.
For SNF, Acute Rehab and LTAC requests, call 801-581-5515 or fax request to 801-585-5600.