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Register for a Temporary Funding Assistance Program webinar or learn more on their website, and find more information on the Provider Portal.
Prior authorization information and forms for providers. Submit a new prior auth, get prescription requirements, or submit case updates for specialties.
Health care professionals are sometimes required to determine if services are covered by UnitedHealthcare. Advance notification is often an important step in this process. Because requests vary, it is important that you verify the specific clinical requirements of each request.
We’ve designed our digital tools to help you seamlessly submit and verify your prior authorizations and advance notifications in real time. While you’re in the tool, you can also easily check requirements, get status updates and more.
UnitedHealthcare Provider Portal – The Prior Authorization and Notification tool allows you to submit inquiries, process requests and get status updates.
Sign in to the portal
Electronic Data Interchange (EDI) allows you to securely and electronically submit and receive batch transactions for multiple cases.
PreCheck MyScript® integrates directly within your EMR so you can easily run a pharmacy trial claim and get real-time prescription coverage details.
Sign in to use PreCheck MyScript.
Crosswalk
For commercial plan participants who need additional services after a prior authorization has been received, please use the Crosswalk table. The table will help you determine whether you can use the approved prior authorization, need to modify the original or request a new one. You can find more helpful details in the Crosswalk information sheet.
Advance notification
Take this first step to help you determine coverage based on medical necessity. Please note, prior authorization may still be required.
Peer-to-peer requests
Peer-to-peer requests are made prior to submitting an appeal. Don’t fill out this form if your appeal has already been initiated.
Regulatory
You can find state-required information regarding services that require pre-service review.
Clinical and specialty pharmacy
Certain medications require notification and review to determine coverage under pharmacy benefits. You can view clinical pharmacy requirements here.
Drug lists
Get pharmacy coverage information including drug lists, supply limits, step therapy and infusion care.
Community Plan prescribers
Access forms used for the manual submission of specific drug prior authorizations.
March 13, 2024
Beginning April 1, we’re updating the service area for Surest benefit plans with out-of-network benefits.
March 13, 2024
Udenyca Onbody is a preferred pegfilgrastim product for UnitedHealthcare commercial plans.
March 08, 2024
Use our updated Prior Authorization Crosswalk to help determine next steps.
January 31, 2024
Submit requests with prior authorizations for DME covered under the Home Health Exceptional Circumstances Provision.
January 31, 2024
Rocky Mountain Health Plans will require prior authorization for listed physician-administered medications in outpatient settings.
January 31, 2024
Starting March 1, 2024, we're updating prior authorization requirements for certain medications to meet state criteria.
There are several ways you can submit prior authorizations, advance notifications and admission notifications (HIPAA 278N):
Chat with us 7 a.m.–7 p.m. CT, Monday – Friday from the UnitedHealthcare Provider Portal.