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
- Prior Authorization and Notification quick start guide
- Prior Authorization and Notification interactive guide
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
September 09, 2024
Outpatient therapy and chiropractic prior authorization requirements
UnitedHealthcare Medicare Advantage plans nationally will require prior authorization for outpatient therapy and chiropractic services.
September 04, 2024
Texas: Hormone drug prior authorization and clinical criteria updates
Starting March 1, 2024, we’re updating prior authorization and clinical criteria requirements for some hormone medications.
September 04, 2024
Improvements to prior authorization process for sacral nerve stimulation for urinary and fecal indications
Starting Oct. 1, we’re improving the prior authorization process for SNS for urinary and fecal indications.
August 30, 2024
Maryland Medicaid: State-required updates to specialty pharmacy prior authorization requirements
Starting Dec. 1, 2024, we will require prior authorization for some specialty medications for Medicaid members in Maryland.
August 30, 2024
Introducing a first-of-its-kind national Gold Card program
National Gold Card program may reduce prior authorizations for high-performing providers.
August 30, 2024
Dec. 1: Electronic appeal submissions required for Arizona Medicaid
Health care professionals must submit Medicaid pre- and post-service appeals electronically in Arizona.
How do I submit a prior authorization, advance notification or admission notification?
There are several ways you can submit prior authorizations, advance notifications and admission notifications (HIPAA 278N):
- Prior authorization and notification tools: These digital options, available in the UnitedHealthcare Provider Portal, allow you to seamlessly submit your requests in real time
- EDI: This digital solution allows you to automate prior authorization and notification tasks
- Provider Services: If you’re unable to use the provider portal, call 877‐842‐3210 to submit a request
- 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.