In order to initiate a prior authorization request, the following essential information (EI) is required:
- Member name
- Member number or Medicaid number
- Member date of birth
- Requesting provider’s name
- Requesting provider’s National Provider Identifier (NPI)
- Rendering provider’s Name
- Rendering Provider’s National Provider Identifier (NPI)
- Rendering Provider’s Tax Identification Number (TIN)
- Service requested – use Current Procedural Terminology (CPT) Healthcare Common Procedure Coding System (HCPCS), or Current Dental Terminology (CDT), as appropriate
- Service requested start and end dates
- Quantity of service units requested based on the CPT, HCPCS, or CDT requested
If a prior authorization request does not contain each of the essential information data points, the request will not be created and will be returned to the provider with guidance on which information is missing.
For information about what other documentation might be required, go to Medical Record Requirements for Pre-Service Reviews.
Current Prior Authorization Requirements
UnitedHealthcare Community Plan - Children's Health Insurance Program (CHIP)
UnitedHealthcare Community Plan - Connected Texas (Medicare-Medicaid Plan)
UnitedHealthcare Community Plan - STAR
UnitedHealthcare Community Plan - STAR Kids
UnitedHealthcare Community Plan - STAR+PLUS
UnitedHealthcare Medicare Solutions & UnitedHealthcare Community Plan (Dual Special Needs Plan) Prior Authorization Requirements
Previous Prior Authorization Requirements
UnitedHealthcare Community Plan - Children's Health Insurance Program (CHIP)
- UnitedHealthcare Community Plan TX CHIP Prior Authorization Requirements - Effective May 1, 2021
- UnitedHealthcare Community Plan TX CHIP Prior Authorization Requirements - Effective April 1, 2021
- UnitedHealthcare Community Plan TX CHIP Prior Authorization Requirements - Effective Feb. 1, 2021
- UnitedHealthcare Community Plan TX CHIP Prior Authorization Requirements - Effective Jan. 1, 2021
- UnitedHealthcare Community Plan TX CHIP Prior Authorization Requirements - Effective Dec. 1, 2020
- UnitedHealthcare Community Plan TX CHIP Prior Authorization Requirements - Effective Nov. 1, 2020
- UnitedHealthcare Community Plan TX CHIP Prior Authorization Requirements - Effective Oct. 1, 2020
- UnitedHealthcare Community Plan TX CHIP Prior Authorization Requirements - Effective July 1, 2020
- UnitedHealthcare Community Plan TX CHIP Prior Authorization Requirements - Effective May 1, 2020
- UnitedHealthcare Community Plan TX CHIP Prior Authorization Requirements - Effective March 1, 2020
- UnitedHealthcare Community Plan TX CHIP Prior Authorization Requirements - Effective Jan.1, 2020
- UnitedHealthcare Community Plan TX CHIP Prior Authorization Requirements - Effective Nov.1, 2019
- UnitedHealthcare Community Plan TX CHIP Prior Authorization Requirements - Effective Oct.1, 2019
UnitedHealthcare Community Plan - Connected Texas (Medicare-Medicaid Plan)
- UnitedHealthcare Connected Texas Prior Authorization Requirements - Effective - May 1, 2021
- UnitedHealthcare Connected Texas Prior Authorization Requirements - Effective Feb. 1, 2021
- UnitedHealthcare Connected Texas Prior Authorization Requirements - Effective Jan. 1, 2021
- UnitedHealthcare Connected Texas Prior Authorization Requirements - Effective Nov. 1, 2020
- UnitedHealthcare Connected Texas Prior Authorization Requirements - Effective Oct. 1, 2020
- UnitedHealthcare Connected Texas Prior Authorization Requirements - Effective July 1, 2020
- UnitedHealthcare Connected Texas Prior Authorization Requirements - Effective April 1, 2020
- UnitedHealthcare Connected Texas Prior Authorization Requirements - Effective Jan.1, 2020
- UnitedHealthcare Connected Texas Prior Authorization Requirements - Effective Nov.1, 2019
- UnitedHealthcare Connected Texas Prior Authorization Requirements - Effective Oct.1, 2019
UnitedHealthcare Community Plan - STAR
- UnitedHealthcare Community Plan TX STAR Prior Authorization Requirements - Effective May 1, 2021
- UnitedHealthcare Community Plan TX STAR Prior Authorization Requirements - Effective April 1, 2021
- UnitedHealthcare Community Plan TX STAR Prior Authorization Requirements - Effective Feb. 1, 2021
- UnitedHealthcare Community Plan TX STAR Prior Authorization Requirements - Effective Jan. 1, 2021
- UnitedHealthcare Community Plan TX STAR Prior Authorization Requirements - Effective Dec. 1, 2020
- UnitedHealthcare Community Plan TX STAR Prior Authorization Requirements - Effective Nov. 1, 2020
- UnitedHealthcare Community Plan TX STAR Prior Authorization Requirements - Effective Oct. 1, 2020
- UnitedHealthcare Community Plan TX STAR Prior Authorization Requirements - Effective Sept. 1, 2020
- UnitedHealthcare Community Plan TX STAR Prior Authorization Requirements - Effective July 1, 2020
- UnitedHealthcare Community Plan TX STAR Prior Authorization Requirements - Effective May 1, 2020
- UnitedHealthcare Community Plan TX STAR Prior Authorization Requirements - Effective March 1, 2020
- UnitedHealthcare Community Plan TX STAR Prior Authorization Requirements - Effective Jan.1, 2020
- UnitedHealthcare Community Plan TX STAR Prior Authorization Requirements - Effective Nov.1, 2019
- UnitedHealthcare Community Plan TX STAR Prior Authorization Requirements - Effective Oct.1, 2019
UnitedHealthcare Community Plan - STAR Kids
- UnitedHealthcare Community Plan TX STAR Kids Prior Authorization Requirements - Effective May 1, 2021
- UnitedHealthcare Community Plan TX STAR Kids Prior Authorization Requirements - Effective April 1, 2021
- UnitedHealthcare Community Plan TX STAR Kids Prior Authorization Requirements - Effective Jan. 1, 2021
- UnitedHealthcare Community Plan TX STAR Kids Prior Authorization Requirements - Effective Dec. 1, 2020
- UnitedHealthcare Community Plan TX STAR Kids Prior Authorization Requirements - Effective Nov. 1, 2020
- UnitedHealthcare Community Plan TX STAR Kids Prior Authorization Requirements - Effective Oct. 1, 2020
- UnitedHealthcare Community Plan TX STAR Kids Prior Authorization Requirements - Effective July 1, 2020
- UnitedHealthcare Community Plan TX STAR Kids Prior Authorization Requirements - Effective May 1, 2020
- UnitedHealthcare Community Plan TX STAR Kids Prior Authorization Requirements - Effective March 1, 2020
- UnitedHealthcare Community Plan TX STAR Kids Prior Authorization Requirements - Effective Jan.1, 2020
- UnitedHealthcare Community Plan TX STAR Kids Prior Authorization Requirements - Effective Nov.1, 2019
- UnitedHealthcare Community Plan TX STAR Kids Prior Authorization Requirements - Effective Oct.1, 2019
UnitedHealthcare Community Plan - STAR+PLUS
- UnitedHealthcare Community Plan TX STAR+PLUS Prior Authorization Requirements - Effective May 1, 2021
- UnitedHealthcare Community Plan TX STAR+PLUS Prior Authorization Requirements - Effective April 1, 2021
- UnitedHealthcare Community Plan TX STAR+PLUS Prior Authorization Requirements - Effective Feb. 1, 2021
- UnitedHealthcare Community Plan TX STAR+PLUS Prior Authorization Requirements - Effective Jan. 1, 2021
- UnitedHealthcare Community Plan TX STAR+PLUS Prior Authorization Requirements - Effective Dec. 1, 2020
- UnitedHealthcare Community Plan TX STAR+PLUS Prior Authorization Requirements - Effective Nov. 1, 2020
- UnitedHealthcare Community Plan TX STAR+PLUS Prior Authorization Requirements - Effective Oct. 1, 2020
- UnitedHealthcare Community Plan TX STAR+PLUS Prior Authorization Requirements - Effective Sept. 1, 2020
- UnitedHealthcare Community Plan TX STAR+PLUS Prior Authorization Requirements - Effective July 1, 2020
- UnitedHealthcare Community Plan TX STAR+PLUS Prior Authorization Requirements - Effective May 1, 2020
- UnitedHealthcare Community Plan TX STAR+PLUS Prior Authorization Requirements - Effective March 1, 2020
- UnitedHealthcare Community Plan TX STAR+PLUS Prior Authorization Requirements - Effective Jan.1, 2020
- UnitedHealthcare Community Plan TX STAR+PLUS Prior Authorization Requirements - Effective Nov. 1, 2019
- UnitedHealthcare Community Plan TX STAR+PLUS Prior Authorization Requirements - Effective Oct.1, 2019