Prior authorization and notification requirements - 2022 UnitedHealthcare Administrative Guide
UMR prior authorization capabilities are not available on uhcprovider.com. Instead, you can reference the How to contact UMR section in this supplement for tools and resources.
We may refer to the terms “preauthorization,” “prior authorization” or “precertification” in the supplement and in our resources. These terms are used interchangeably.
Advance notification/prior authorization lists
Services requiring advance notification and prior authorization vary by plan and can change. Services requiring prior authorization require a clinical coverage review based on medical necessity.
Advance notification/prior authorization lists are available at umr.com through a lookup feature best used in the Google Chrome web browser. You can view the most up-to-date plan-specific requirements. You must have the member’s ID card to obtain accurate information.
How to submit advance notification or prior authorization requests
UnitedHealthcare’s prior authorization and notification (PAAN) tool does not access UMR membership. Instead, you may submit an advance notification or prior authorization in 1 of 3 ways, all of which require the member’s ID card:
Watch this training for more information about online capabilities.
After submitting a request online, you will receive a confirmation email with a transaction reference number. This is not a determination. Once we process your request, you will receive a status email with the request reference number. You can then login and view the status of your request using the member ID number and selecting “Transactions” from the Welcome menu.
Phone: Call the number listed on the back of the member ID card.
After submitting a request by fax or phone, you will be given a request reference number. This is not a determination. When we make a coverage decision, we will issue the decision under the same request number.
Clinical request forms
Some clinical requests for predetermination or prior authorization (i.e., spinal surgery or genetic testing) require specific forms that you must submit with the request. Find clinical request forms at umr.com > Provider > Find a Form.