Your primary UnitedHealthcare prior authorization resource, the Prior Authorization and Notification tool, is available on the UnitedHealthcare Provider Portal, UnitedHealthcare’s self-service tools for providers. Learn more.
Medical Records Requirement for Pre-Service: Prepare suggested materials in advance to decrease the need for repeated requests, improve turnaround time for medical records reviews and help improve the claims process.
A peer to peer review is an optional, but recommended, service intended to improve both the UnitedHealthcare-physician experience and the physician-patient experience. During a peer to peer review, a UnitedHealthcare clinical director will discuss the following with the physician and/or facility:
Medical policies used to make a prior authorization decision
New clinical information the physician/facility may have that was unavailable at the time of original prior authorization submission
What to know before making your request
Peer to peer requests can only be made prior to submitting an appeal. Don’t fill out this form if you have already initiated an appeal.
If you are submitting on behalf of a physician, please ensure they’re willing to speak with the UnitedHealthcare clinical director that reviewed the prior authorization request
You will need to provide an actively monitored phone number that will be picked up by a member of your team leading up to and on the designated day and time
Please ensure the physician is aware of and available for the peer to peer review during the confirmed day and time
What’s needed to request a review
Before beginning a peer to peer request, please have the following information ready:
For general questions about peer to peer reviews, please call UnitedHealthcare Provider Services, toll-free, at 877-842-3210, 7 a.m.–5 p.m. CT, Monday–Friday. To schedule or reschedule a peer to peer review, contact the peer to peer support team by email at UHC_PeerToPeer_Scheduling@uhc.com or, toll-free, at 800-955-7615, 7 a.m.–7 p.m. CT, Monday–Friday.
Check current prescription coverage and price, including out-of-pocket prescription costs for UnitedHealthcare members at their selected pharmacy with the PreCheck MyScript Tool in the UnitedHealthcare Provider Portal.
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.
We’re continuously looking for ways to provide greater administrative simplicity for care providers and reduce the costs of doing business with us.
As part of this effort, we retired certain fax numbers for medical prior authorization requests in 2019, and asked you to use the Prior Authorization and Notification tool in the UnitedHealthcare Provider Portal — the same website you use to check eligibility and benefits, manage claims and update your demographic information.
In line with UnitedHealthcare’s multi-year efforts to go digital, Admission Notification fax numbers used by facilities to notify us that a member has been hospitalized will be retired in phases this year. Instead of faxing your notification, we ask you to use the HIPAA Electronic Data Interchange (EDI) 278N transaction or the Prior Authorization and Notification tool in the UnitedHealthcare Provider Portal.