UnitedHealthcare Community Plan of Texas annually reviews our health plan prior authorization policies in accordance with Texas Government Code Section §533.00283. The policies are normally reviewed each October for the previous Texas Health and Human Services fiscal year (Sept. 1 through Aug. 31). For more information, call Customer Service at 888-887-9003.
Care decisions are based on medical necessity in accordance with care guidelines developed by both UnitedHealthcare and the Texas Health and Human Services Commission. Services must be outcome-driven, clinically necessary, evidence-based and provided in the least restrictive environment possible. We don’t reward our staff or providers for issuing denials of coverage for service care. Utilization management decision-makers don’t receive financial or other incentives that encourage decisions resulting in underutilization of services.
Emergency medical conditions and emergency behavioral health conditions do not require prior authorization.
Need More Help?
If you have questions about prior authorization please call Customer Service at 888-887-9003, Monday – Friday, 8 a.m. - 6 p.m. Central Time.
To check on the status of an existing request, please call our clinical authorization services at 888-887-9003. This is available 24 hours a day, seven days a week.
If you have pharmacy prior authorization questions, please visit the Pharmacy Resources section or call our Pharmacy Help Desk at 800-310-6826, Monday - Friday, 7 a.m. to 7 p.m. Central Time, with voicemail intake after-hours.
If your patient who is a UnitedHealthcare Community Plan member has questions about prior authorization requirements, they can call one of the following Member Services numbers, Monday – Friday, 8 a.m. - 6 p.m. Central Time: