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March 15, 2024 at 6:00 PM CT

Important Update -- Change Healthcare is experiencing a cyber security issue. Once we became aware of the outside threat, in the interest of protecting our partners and patients, we took immediate action to disconnect our systems to prevent further impact.

Register for a Temporary Funding Assistance Program webinar or learn more on their website, and find more information on the Provider Portal.

Prior Authorization and Notification

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. 

 

Digital tools

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.

Medical professional digital tools


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. 

Pharmacy digital tools


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.

Medical professional resources 

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.

Pharmacy resources

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.

Specialty specific resources

Prior Authorization news

Surest out-of-network service area update

Beginning April 1, we’re updating the service area for Surest benefit plans with out-of-network benefits.

Udenyca Onbody is a preferred pegfilgrastim product

Udenyca Onbody is a preferred pegfilgrastim product for UnitedHealthcare commercial plans.

Streamline prior authorizations with our crosswalk

Use our updated Prior Authorization Crosswalk to help determine next steps.

Texas Medicaid: DME exceptional circumstances provision

Submit requests with prior authorizations for DME covered under the Home Health Exceptional Circumstances Provision.

Rocky Mountain Health Plans: Prior authorization updates starting May 1, 2024

Rocky Mountain Health Plans will require prior authorization for listed physician-administered medications in outpatient settings.

Texas: Prior authorization updates for certain medications

Starting March 1, 2024, we're updating prior authorization requirements for certain medications to meet state criteria.

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There are several ways you can submit prior authorizations, advance notifications and admission notifications (HIPAA 278N):

  1. Prior authorization and notification tools: These digital options, available in the UnitedHealthcare Provider Portal, allow you to seamlessly submit your requests in real time
  2. EDI: This digital solution allows you to automate prior authorization and notification tasks
  3. Provider Services: If you’re unable to use the provider portal, call 877‐842‐3210 to submit a request
  4. Fax: You can submit requests by fax to 855‐352‐1206. Please note: This option is only available for the following commercial plans: Massachusetts, Nevada, New Mexico and Texas.

Need help?

Chat with us 7 a.m.–7 p.m. CT, Monday – Friday from the UnitedHealthcare Provider Portal

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