Provider Forms and References | UnitedHealthcare Community Plan of Indiana
Last update: April 1, 2025
See the items below to stay up-to-date with forms, reference guides, and other items that are important to your practice.
Provider Forms
- Authorization for Release of Health information - English
- Authorization for Release of Health information – Spanish
- Consent for Sterilization HHS-687 Form
- Consent for Sterilization HHS-687 Form Spanish Formulario de consentimiento de esterilización
- IHCP MCE Hospital/Ancillary Provider Enrollment Form
- IHCP MCE Practitioner Enrollment Form
- Indiana PathWays Hospice Notification Form
- Primary Health Care Professional PCP Panel Add Request Form
- Synagis Enrollment Form
Submit a Pre-Service Appeal and or Grievance for a Medicaid Member