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February 26, 2024 at 8:00 AM CT

If you are experiencing connectivity issues with UnitedHealthcare, please use our secure self-service options in the UnitedHealthcare Provider Portal or an existing API connection. The portal is currently available to check eligibility, manage claim reconsiderations and appeals, and submit prior authorization requests.

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. While you’re in the tool, you can also easily check requirements, get status updates and more.

Medical professional digital tools


UnitedHealthcare Provider Portal –
The Prior Authorization and Notification tool allows you to submit inquiries, process requests and get status updates. 

Sign in to the portal


Electronic Data Interchange (EDI)
allows you to securely and electronically submit and receive batch transactions for multiple cases. See the flyer for details.

Pharmacy digital tools


PreCheck MyScript® integrates directly within your EMR so you can easily run a pharmacy trial claim and get real-time prescription coverage details.

Sign in to use PreCheck MyScript.

Medical professional resources 

Crosswalk
For commercial plan participants who need additional services after a prior authorization has been received, please use the Crosswalk table. The table will help you determine whether you can use the approved prior authorization, need to modify the original or request a new one. You can find more helpful details in the Crosswalk information sheet.

Advance notification
Take this first step to help you determine coverage based on medical necessity. Please note, prior authorization may still be required. 

Peer-to-peer requests
Peer-to-peer requests are made prior to submitting an appeal. Don’t fill out this form if your appeal has already been initiated.

Regulatory
You can find state-required information regarding services that require pre-service review.

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.

Specialty specific resources

Prior Authorization news

Texas Medicaid: DME exceptional circumstances provision

Submit requests with prior authorizations for DME covered under the Home Health Exceptional Circumstances Provision.

Rocky Mountain Health Plans: Prior authorization updates starting May 1, 2024

Rocky Mountain Health Plans will require prior authorization for listed physician-administered medications in outpatient settings.

Texas: Prior authorization updates for certain medications

Starting March 1, 2024, we're updating prior authorization requirements for certain medications to meet state criteria.

Texas: Hormone drug prior authorization and clinical criteria updates

Starting March 1, 2024, we’re updating prior authorization and clinical criteria requirements for some hormone medications.

North Carolina Medicaid: Avoid claim denials

Find out how to submit a retroactive transition of care prior authorization.

Rocky Mountain Health Plans: Outpatient prior authorization changes

Rocky Mountain Health Plans will require prior authorization for non-oncology, physician-administered medications provided in outpatient settings.

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There are several ways you can submit prior authorizations, advance notifications and admission notifications (HIPAA 278N):

  1. Prior authorization and notification tools: These digital options, available in the UnitedHealthcare Provider Portal, allow you to seamlessly submit your requests in real time
  2. EDI: This digital solution allows you to automate prior authorization and notification tasks
  3. Provider Services: If you’re unable to use the provider portal, call 877‐842‐3210 to submit a request
  4. 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?

Chat with us 7 a.m.–7 p.m. CT, Monday – Friday from the UnitedHealthcare Provider Portal

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