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UniCare is becoming Wellpoint
Same doctors. Same hospitals. Same commitment. New name.
 

Provider Forms and Documents

 

Browse commonly requested forms and documents on various topics such as prior authorization information.

Provider Reference Sheet

Use this document as a convenient reference for member copays, notification requirements for preapprovals, and selected procedures for pre-review.

Please refer to the applicable member handbook, found in our member materials, for more information on plan benefits, conditions, limitations, and exclusions.

Download Provider Reference Sheet

Outbound Fax Information Form for UM Decision Letters

Use this form to begin receiving UniCare utilization management decision letters for approvals, denials, and requests for information by fax.

Download Outbound Fax Information Form for UM Decision Letters

HealthCare Administrative Solutions (HCAS) Provider Enrollment Form

Use this form to enroll as a UniCare contracted provider. Please complete a separate page for all new providers in the group.

Download HCAS Provider Enrollment Form

Provider Information Change Form

If you're an existing UniCare contracted provider, use this form to let us know about changes to your practice, such as the names of new providers in your group.

Download Provider Information Change Form
 

Member ID Cards

View samples of the member ID cards for all four plans. UniCare ID cards show copay amounts and other plan information.