Physician Referral Fax Form Fax # 954.355.4881 - Broward Health - browardhealth-2025

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Please complete this entire form and fax it to: 866-940-7328. If you have questions, please call 800-310-6826.
To have your doctor make a request Your doctor or provider can contact UnitedHealthcare at 1-800-711-4555 for the Prior Authorization department to submit a request. The plans decision on your request will be provided to you by telephone and/or mail.
Go to Claim Information for a list of addresses of where you can mail paper claims. ► Can I fax a claim? We accept claims by fax at 248-733-6372, apart from those indicated below.
What is the fax number for United Healthcare Utah? Fax: 1-844-386-9286 Please keep a copy of this form for your records.
Appointment Request Form If you would prefer to contact the Centralized Scheduling Department rather than utilize the electronic request, please call 954-759-7500.
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Referral Request Form To request a referral, please have the UnitedHealthcare Community Plan members assigned primary care provider (PCP) complete, sign and submit this form. Fax the form to 8886242748.

248 733 6000