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.
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.
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.
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.
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.
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.
October 01, 2023
On Jan. 1, 2024, we'll launch Individual Exchange plans in 4 new states. Learn more.
October 01, 2023
Starting Nov. 1, prior authorizations for oral chemotherapeutics will only be accepted through the Cancer Guidance Program.
October 01, 2023
For dates of service starting Jan. 1, 2024, prior authorization is required for Part B step therapy program medications.
September 21, 2023
Find more information on service area changes for Medicare Advantage plans.
September 21, 2023
View the medical guidelines and criteria Rocky Mountain Health Plans uses to help make determinations on prior authorizations and other benefit decisions.
September 12, 2023
Prior authorizations are required starting Sept. 17 for Aubagio®, Vascepa®, Austedo® medications and Oct. 15 for Gattex®.
There are several ways you can submit prior authorizations, advance notifications and admission notifications (HIPAA 278N):