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Prior Authorization Forms

UNI-MDP-MDM- Prior Authorization Forms - Information for Prescription Drugs

Prior Authorization and Exception Request Forms:

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Univera Healthcare contracts with the Federal Government and is an HMO plan with a Medicare contract. Enrollment in Univera Healthcare depends on contract renewal. Submit a complaint about your Medicare plan at www.Medicare.gov or learn about filing a complaint by contacting the Medicare Ombudsman. Y0028_5996_C.

This page last updated 10-01-2019.