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 tool, is available on the UnitedHealthcare Provider Poratl, UnitedHealthcare’s self-service tools for providers. Learn more.
To see more information on any of these areas, open a section below to view more information.
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.
M&R Part B Specialty Medical Injectable Drugs QRG: This Quick Reference Guide (QRG) informs providers about changes to the Prior Authorization process for Part B drugs, that became effective January 3, 2022.
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:
What to know before making your request
What’s needed to request a review
Before beginning a peer to peer request, please have the following information ready:
Please see the Administrative Guide for Commercial, Medicare Advantage and DSNP for complete information on health care professional and facility peer to peer requests.
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 on Link.
If you do not yet have access to the PreCheck MyScript tool, 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.
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 on Link — 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 on Link.
Looking for Pharmacy information? More forms can be found in the Clinical Pharmacy and Specialty Drugs Prior Authorization Programs section.