This is a summary of the Prior Authorization and Notification Program and is not meant to be comprehensive. Please refer to the UnitedHealthcare Administrative Guide for program details and required protocols.
California and Washington providers, hospitals and other acute inpatient facilities are subject to the admission notification requirements described in the UnitedHealthcare Administrative Guide.
If prior authorization or advance notification is needed for the requested elective inpatient procedure, it is the physician's responsibility to obtain the relevant approval.
The facility must notify UnitedHealthcare within 24 hours (or the following business day if the admission occurs on a weekend or holiday) of the elective admission. If the physician has obtained prior authorization or advance notification, the initial day of the inpatient admission will be paid, unless:
If advance notification is obtained but is not made by the facility in a timely manner, payment reductions will be limited to hospital room and board charges, when applicable.
Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates. Health plan coverage provided by UnitedHealthcare of Arizona, Inc., UHC of California DBA UnitedHealthcare of California, UnitedHealthcare Benefits Plan of California, UnitedHealthcare of Colorado, Inc., UnitedHealthcare of the Mid-Atlantic, Inc., MAMSI Life and Health Insurance Company, UnitedHealthcare of New York, Inc., UnitedHealthcare Insurance Company of New York, UnitedHealthcare of Oklahoma, Inc., UnitedHealthcare of Oregon, Inc., UnitedHealthcare of Pennsylvania, Inc., UnitedHealthcare of Texas, Inc., UnitedHealthcare Benefits of Texas, Inc., UnitedHealthcare of Utah, Inc., UnitedHealthcare of Washington, Inc., Optimum Choice, Inc., Oxford Health Insurance, Inc., Oxford Health Plans (NJ), Inc., Oxford Health Plans (CT), Inc., All Savers Insurance Company, or other affiliates. Administrative services provided by OptumHealth Care Solutions, LLC, OptumRx, Oxford Health Plans LLC, United HealthCare Services, Inc., or other affiliates. Behavioral health products provided by U.S. Behavioral Health Plan, California (USBHPC), or its affiliates.