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, Radiology, Clinical 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 >
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.
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.
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.
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.
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.
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.
- Commercial Standard Prior Authorization Request Form
- Mid-Atlantic Health Plans Universal Request for Prior Authorization
- Florida Pre-Service Reconsideration Request Form
- Indiana Standard Prior Authorization Request Form for Health Care Services
- Massachusetts Commercial Prior Authorization Form - Cardiac Imaging Prior Authorization Form
- Massachusetts Commercial Prior Authorization Form - CT/CTA/MRI/MRA Prior Authorization Form
- Massachusetts Commercial Prior Authorization Form - Hepatitis C Medication Requests
- Massachusetts Commercial Prior Authorization Form - Non-OB Ultrasound Requests
- Massachusetts Commercial Prior Authorization Form - PET CT Imaging Authorization Form
- Massachusetts Commercial Prior Authorization Form - SYNAGIS® Requests
- Texas Standard Prior Authorization Request Form for Health Care Services
Other Helpful Resources
- Florida Pre-Service Reconsideration Process – Effective Nov. 1, 2017
- Inpatient Admission Notification and Case Management Process for Skilled Nursing Facilities
- Medical Records Required for Post-Service Medical Necessity Facility Reviews
- Medical Records Requirement for Pre-Service
- Medicare Advantage Prior Authorization Reduction Frequently Asked Questions
- Medicare Part D Prior Authorization Guidelines
- Pre-Determination Fax Form for Services that Do Not Require Prior Authorization - Commercial Members Only