Skip to main content
Providers

MEDICAL PROVIDER FORMS

Get fast, easy access to downloadable forms.

Medical Prior Authorization

Download medical prior authorization forms here.

Find Medical Prior Authorization Forms

Pharmacy Prior Authorization

Download pharmacy prior authorization forms here.

Find Pharmacy Prior Authorization Forms

Notice of Medicare Non-Coverage (NOMNC) Form

Download NOMNC Forms here. These forms are for Skilled Nursing Facilities, Comprehensive Outpatient Rehabilitation Facilities, and Home Health Providers.

View NOMNC Forms

Personal Designation

Providers may submit the completed form on behalf of the member by emailing HIPAAForms@upmc.edu. The submitted form will be processed within 1-2 business days.

View Personal Designation Form