Page 111 - R2P Front Desk Manual v1

How to Submit a Rehab Extension Request Form for MDIPA

Any patient with a United Healthcare MDIPA plan MUST have a referral from their Primary Care
Provider (PCP). The Dr.’s name on the referral must match the PCP that is linked to the
patient’s insurance plan, which can be found when viewing patient information online through
the UHC portal and when speaking to a representative to verify benefits; if it does not match,
instruct the patient to log in to their UHC account and update their PCP information.

MDIPA plans require a referral for the first 8 LIFETIME visits PER BODY PART. After the
8th LIFETIME visit, the clinic must fax a completed Rehabilitation Services Extension Request
Form to MDIPA at 888-831-5080 for review and approval of additional visits. The link to the pdf
form is found on the UHC website or by following the steps below.
*PLEASE NOTE: The Rehab Extension Request form can only be backdated 1 day!*

To access the Rehab Extension Request Form without using the above link to the pdf:
1. Go to https://www.uhcprovider.com/.
2. In the top left corner, select Menu and choose Health Plans by State.

Last Update: 7/10/19