Prior Authorization and Notification
In this section you will find the tools and resources you need to help manage your practice’s prior authorization and notification requirements, with program specific information available for Cardiology, Oncology, Radiology, Clinical Pharmacy and Specialty Drugs.
Your primary UnitedHealthcare prior authorization resource, the Prior Authorization and Notification tool, is available on Link, UnitedHealthcare’s self-service tools. Learn more.
What Would You Like to Do?
To see more information on any of these areas, click on the plus sign (+) next to their title.
Helpful Resources
Medical Records Requirement for Pre-Service: Prepare suggested materials in advance to decrease the need for repeated requests, improve turnaround time for medical records reviews and help improve the claims process.
For information on specific prior authorization and notification clinical programs by specialty, choose from below:
Check current prescription coverage and price, including out-of-pocket prescription costs for UnitedHealthcare members at their selected pharmacy with the PreCheck MyScript Tool on Link.
- Get information on lower-cost prescription alternatives, if available, to help save members money.
- See which prescriptions currently require prior authorization, or are non-covered or non-preferred.
- Request prior authorization and receive status and results.
Learn more about PreCheck MyScript Solution.
If you do not yet have access to the PreCheck MyScript tool, you may request it from the Link Marketplace.
Note: This application is available to physicians and facilities, not to pharmacies.
Starting Nov. 1, 2017, notification is required for certain genetic and molecular lab tests for certain UnitedHealthcare Commercial benefit plans.
Ordering care providers will complete the notification/prior authorization process online or over the phone.
Labs must register their tests to participate as part of the Genetic and Molecular Lab Testing Notification/Prior Authorization process.
Learn more about the Genetic & Molecular Lab Testing Notification / Prior Authorization Process.
We’re continuously looking for ways to provide greater administrative simplicity for care providers and reduce the costs of doing business with us.
As part of this effort, we retired certain fax numbers for medical prior authorization requests in 2019, and asked you to use the Prior Authorization and Notification tool on Link — the same website you use to check eligibility and benefits, manage claims and update your demographic information.
Learn more about retired medical prior authorization fax numbers.
In line with UnitedHealthcare’s multi-year efforts to go digital, Admission Notification fax numbers used by facilities to notify us that a member has been hospitalized will be retired in phases this year. Instead of faxing your notification, we ask you to use the HIPAA Electronic Data Interchange (EDI) 278N transaction or the Prior Authorization and Notification tool on Link.
Learn more about retiring Admission Notification fax numbers.
Forms
Looking for Pharmacy information? More forms can be found in the Clinical Pharmacy and Specialty Drugs Prior Authorization Programs section.
- Peer to Peer Scheduling Request Form - UnitedHealthcare offers the opportunity for your physician to speak with our medical director to discuss the medical policy and documentation requirements which determined the response for your prior authorization or concurrent review request.
- Fertility Solutions Prior Authorization Request Form for Medications - Commercial
- UnitedHealthcare Community Plan (Medicaid) Pre-Service Appeals & Grievances
State-Specific Resources
- California Doctors Plan Prior Authorization List
- California Doctors Plan Prior Authorization Process
- Indiana Standard Prior Authorization Request Form for Health Care Services
(Please note: Fax is not a secure method of transmission. Use the Online Prior Authorization and Notification tool.) - KanCare Medicaid Behavioral Health Inpatient Prior Authorization Request Form
- KanCare Medicaid Behavioral Health PRTF Prior Authorization Request Form
- Massachusetts Commercial Prior Authorization Form - Cardiac Imaging Prior Authorization Form
- Massachusetts Commercial Prior Authorization Form - CT/CTA/MRI/MRA Prior Authorization Form
- Massachusetts Commercial Prior Authorization Form - Hepatitis C Medication Requests
- Massachusetts Commercial Prior Authorization Form - Non-OB Ultrasound Requests
- Massachusetts Commercial Prior Authorization Form - PET CT Imaging Authorization Form
- Massachusetts Commercial Prior Authorization Form - SYNAGIS® Requests
- Nevada Commercial Standard Prior Authorization Request Form - Medical
- New Mexico Commercial Prior Authorization Form - Medical
- NY External Appeal Application
- Texas Standard Prior Authorization Request Form for Health Care Services
- West Virginia Commercial Prior Authorization Request Form
Additional Resources
- Active Admission Notification/Prior Authorization/Advance Notification Fax Numbers
- Expanded Community Plan Notification/Prior Authorization Requirements and Site of Service Medical Necessity Reviews for Certain Surgical Procedures - FAQ– Effective Nov. 1, 2019 for MD, RI, WA, MI, MO, OH
- Medical Records Requirement for Pre-Service
- Medicare Part D Prior Authorization Guidelines
- Participating Laboratories - Frequently Asked Questions
- Patent Foramen Ovale (PFO) Closure- Frequently Asked Questions
- Prior Authorization and Site of Service Reviews for Surgical Codes - Frequently Asked Questions
- Prior Authorization and Site of Service Reviews - UnitedHealthcare Exchange Plans - Frequently Asked Questions
- Site of Service Reviews for Surgical Procedures - UnitedHealthcare Medicare Advantage Plans - Frequently Asked Questions