Spine Surgery Information Request Fax Form to Speed Precertification
Now Available for UnitedHealthcare Oxford Commercial Members
The Spine Surgery Information Request Fax Form is now available for UnitedHealthcare Oxford
Commercial members. By using the fax form, you can quickly send clinical information for
UnitedHealthcare Oxford precertification of planned spinal surgery procedures and bone graft materials.
This means you can receive timely, accurate benefit determinations and avoid denials of bone or soft
tissue healing and fusion enhancement products due to lack of authorization.
OrthoNet, a musculoskeletal disease management company, manages the medical necessity review for
surgical treatment for spine pain on our behalf and will begin accepting the fax form for prior
authorization requests on June 1, 2015.
Please fax completed forms to 914-323-9266. If you have questions, or an emergent request for surgery,
please call OrthoNet at 888-381-3152.
UnitedHealthcare Oxford Commercial Spine
Surgery Information Request Form
Spine Surgery Information Request Form
UnitedHealthcare Oxford Commercial Surgical
Treatment for Spine Pain Clinical Policy
Surgical Treatment for Spine Pain
UnitedHealthcare Oxford Commercial Bone or Soft
Tissue Healing and Fusion Enhancement Products
Clinical Policy
Bone or Soft Tissue Healing and Fusion
Enhancement Products
Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates. Oxford Health
Plans (NJ Individual), Inc. and Oxford Health Plans (CT), Inc. Oxford insurance products are underwritten by Oxford
Health Insurance, Inc., Oxford CT and NJ Individual Health Plans
Doc#: PCA16488_20150428
MS-15-262p