Thank you for your interest in submitting a pre-certification request via web-form. At this time, the web-form is only available on desktops.
HAGA CLICK AQUÍ PARA LA VERSIÓN ESPAÑOLA
Patient or Patient Healthcare representative: Utilization Review Plan Requirements - For notifications specific to your state, click on your state:
You have accessed the MedWatch precertification form. Please enter as much information as possible in the spaces provided, even if you do not have all the information requested on this form. The data from this website is received daily during our regular business hours. You will
receive a response within 24 hours of the first business day following the referral.
If you do not receive a response please contact MedWatch to verify that your information has been transmitted to us. We can be reached at 1-800-432-8421 from 7am-6pm ET Monday through Friday.
Use numbers only for Time, Date, and Social Security Number fields.
Notes (Reason for Precertification):
Submission of this data to MedWatch does not verify certification, benefits, or coverage. Please contact MedWatch at 1-800-432-8421 for certification questions. Please contact your claims office for benefits or payment information.