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.

Sign in to begin using digital tools. New to the portal? Register now. 

Medical professional digital tools

Prior Authorization and Notification is the digital tool that helps you submit inquiries, process requests and get status updates.

For helpful tips and instructions, please refer to the guide.

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 

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.

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

Genetic and Molecular Testing

See requirements


See requirements

Prior Authorization news

Medicare Advantage service area changes

Find more information on service area changes for Medicare Advantage plans.

Rocky Mountain Health Plans medical criteria is available

View the medical guidelines and criteria Rocky Mountain Health Plans uses to help make determinations on prior authorizations and other benefit decisions.

Texas Medicaid: New drug prior authorizations

Prior authorizations are required starting Sept. 17 for Aubagio®, Vascepa®, Austedo® medications and Oct. 15 for Gattex®.

Genitourinary Pathogen medical policy ending

Genitourinary Pathogen Nucleic Acid Detection Testing medical policy and related prior authorization requirements ending.

New Empire Plan mailing address for contractual notices

Send required written notices to Empire Plan’s updated mailing address starting Sept. 1.

Maryland Medicaid: Changes to biomarker test for companion diagnostic testing

Beginning Sept. 1, we’re implementing new coverage criteria for biomarker tests. Learn more about these changes.

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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.