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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, RadiologyClinical Pharmacy and Specialty Drugs.

Your primary UnitedHealthcare prior authorization resource, the Prior Authorization and Notification app, is available on Link, the gateway to UnitedHealthcare’s self-service tools. Learn more >

New Prior Authorization Enhancements Include Removal of Some Radiology and Cardiology Requirements - Beginning January 1, 2018

Your input in action: Beginning January 1,2018, prior authorization will no longer be required for CTs, MRIs and Echocardiograms for Medicare and Retirement members only. In addition, we’re eliminating more than 600 different surgical codes across all types of plans and updating other codes for consistency with AMA’s 2018 Current Procedure Terminology.  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 - To decrease the need for repeated requests, improve turnaround time for medical records reviews and help improve the claims process, please prepare suggested materials in advance.

Check current prescription coverage and price, including out-of-pocket prescription costs for UnitedHealthcare members at their selected pharmacy with the PreCheck MyScript App 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 app >

If you do not yet have access to the PreCheck MyScript app, you may request it from the Link Marketplace.

Note: This application is available to physicians and facilities, not to pharmacies.

In early 2018, the OptumRx Prior Authorization tool on UnitedHealthcareOnline.com will be retiring. 

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 >

Advance notification is the first step in UnitedHealthcare’s process to determine coverage for a member. Certain services and plans require advance notification so we can determine if they are medically necessary and covered by the member’s plan. We also use the information you submit for case and condition management program referrals. 

Learn more about Advance Admission Plan Requirements >

Starting Nov. 1, 2017, you’ll be able to request a pre-service reconsideration review and ask us to take another look when certain prior authorization requests receive a clinical denial.

Florida Pre-Service Reconsideration Process – Effective Nov. 1, 2017