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. The digital solutions comparison guide can help health care professionals choose which tools are right for them.
UnitedHealthcare Provider Portal
The Prior Authorization and Notification tool allows you to submit inquiries, process requests and get status updates online. Access our quick start guide or interactive guide to learn more.
Medical professional resources
Crosswalk
For commercial, Individual Exchange, Medicare Advantage, and Community plan members, the crosswalk table will help you determine next steps when you need to provide a service different from the prior authorized service. Note: An X in the table means the crosswalk is available. An N/A in the table means Crosswalk is not available. You can find more helpful details in the Crosswalk information sheet.
Advance notification and prior authorization requirements
This is the first step in determining coverage based on medical necessity. Prior authorization may still be required.
Regulatory
You can find state-required information regarding services that require pre-service review.
Pre-service appeals and peer-to-peer requests
Access options for submitting either a pre-service appeal or a peer-to-peer request electronically.
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.
PreCheck MyScript®
A real-time benefit check tool available through the UnitedHealthcare Provider Portal that allows prescribers to easily run a pharmacy trial claim and get prescription coverage detail.
Specialty specific resources
Prior authorization news
April 09, 2025
Medicare: Part B step therapy prior authorization requirements
For dates of service starting Jan. 1, 2025, prior authorization is required for Part B Step Therapy Program medications.
March 28, 2025
Arizona: No referrals required with HMO Open Access
As of Jan. 1, 2024, all of our Medicare HMO H0609 plans no longer require referrals.
March 10, 2025
Verify address to avoid APWUHP claim appeal delays
Claim appeals addressed incorrectly may be delayed or go unanswered. And APWUHP members to be assigned a new group number.
March 07, 2025
Home health and private duty nursing services prior authorization process
Home health and private duty nursing service prior authorization requests are assessed based on medical necessity and more.
January 27, 2025
Updates to pharmacy prior authorization and step therapy requirements
Effective Jan. 1, 2025, Optum Rx will manage pharmacy prior authorizations and step therapy requests for Golden Rule plans.
December 11, 2024
Review the UnitedHealthcare Medicare Part D drug cost and formulary changes
On Jan. 1, several changes to the UnitedHealthcare Medicare Part D drug costs and formulary will go into effect.
How do I submit a prior authorization, advance notification or admission notification?
There are several ways you can submit prior authorizations, advance notifications and admission notifications (HIPAA 278N):
- Prior authorization and notification tools: These digital options, available in the UnitedHealthcare Provider Portal, allow you to seamlessly submit your requests in real time
- EDI: This digital solution allows you to automate prior authorization and notification tasks
- Provider Services: If you’re unable to use the provider portal, call 877‐842‐3210 to submit a request
- 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?
Connect with us through chat 24/7 in the UnitedHealthcare Provider Portal.