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Advance Notification and Clinical Submission Requirements

Advance notification 

Advance notification is the first step in to determining member coverage based on medical necessity. Prior authorization may still be required. 

Clinical submission

Clinical submission requirements may be required for specialties like physical therapy and occupational therapy. This process is handled through Optum and can be initiated on the Optum Provider Portal.   

Please see individual plan requirements below for specific requirements. 

Updated notice of changes to plan requirements

Services that require advance notification are specified by plan.

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Current Prior Authorization Requirements

Previous Prior Authorization Requirements

Current Prior Authorization Requirements

Previous Prior Authorization Requirements

Current Prior Authorization Requirements

Current Prior Authorization Requirements

Current Prior Authorization Requirements

Previous Prior Authorization Requirements

Current Prior Authorization Requirements

Previous Prior Authorization Requirements

Behavioral Health

Predeterminations are requests that services or treatments be approved before they have been received (also known as preservice claim determinations).  If you would like to request a Predetermination, please fill the below form and attach it to your UnitedHealthcare Provider Portal submission with supporting clinical.  The specifics on supporting clinical can be found under the Prior Authorization and Notification section of this website.  Or you can fax the form and clinical to 845-249-2932.

Current Prior Authorization Requirements

Previous Prior Authorization Requirements

Current Prior Authorization Requirements

Previous Prior Authorization Requirements

For UnitedHealthcare Community Plan, please visit our Health Plans by State section and select the appropriate state, then Community Plan to view current lists. 

For UnitedHealthcare Special Needs Plans, view the Medicare Advantage requirement list found lower on this page.