Search

add_alert
May 30, 2024 at 8:00 AM CT

For information on the Change Healthcare cyber response, find updated information on the Provider Portal. You can also learn more about the Temporary Funding Assistance Program on the Optum website.

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. 

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, 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
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

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.

Colorado: No referrals required with HMO Open Access

As of Jan. 1, 2024, all of our Medicare HMO H0609 plans no longer require referrals.

RMHP Individual Exchange plans to align with hospital reference lab protocol

Effective Sept. 1, UnitedHealthcare Hospital Reference Lab Protocol will apply to RMHP Individual Exchange plans.

Surest plans: Change to oncology prior authorization process

As of July 1, 2024, prior authorization requests for Surest plans and Surest Flex plans must be submitted using Optum CGP.

Surest medical injectable policies to align with UnitedHealthcare commercial plans policies

Starting Aug. 1, we’re updating some Surest™ medical injectable policies to align with UnitedHealthcare commercial plans policies.

North Carolina: Get accurate rates for non-routine infant care

Learn when notification is required after rendering non-routine care to infants and how noncompliance can affect your rate.

Expand All add_circle_outline

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?

Connect with us through chat 24/7 in the UnitedHealthcare Provider Portal.