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 1. Home
 2. Prior Authorization and Notification

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May 2, 2024 at 8:00 AM CT

Important Update -- Change Healthcare is experiencing a cyber security issue.
Once we became aware of the outside threat, in the interest of protecting our
partners and patients, we took immediate action to disconnect our systems to
prevent further impact.

Register for a Temporary Funding Assistance Program webinaropen_in_new or learn
more on their websiteopen_in_new, and find more information on the Provider
Portal.




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 inopen_in_new to the portal

 * Prior Authorization and Notification quick start guideopen_in_new
 * Prior Authorization and Notification interactive guideopen_in_new


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 inopen_in_new to use PreCheck MyScript.






MEDICAL PROFESSIONAL RESOURCES 

Crosswalkopen_in_new
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
sheetopen_in_new. 

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 requestsopen_in_new
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


CARDIOLOGY



See requirements Cardiology


ONCOLOGY



See requirements Oncology


RADIOLOGY



See requirements Radiology


GENETIC AND MOLECULAR TESTING



See requirements Genetic and Molecular Testing


GASTROENTEROLOGY



See requirements Gastroenterology



PRIOR AUTHORIZATION NEWS

See all news arrow_forward

April 30, 2024


SUREST MEDICAL INJECTABLE POLICIES TO ALIGN WITH UNITEDHEALTHCARE COMMERCIAL
PLANS POLICIES



Starting Aug. 1, we’re updating some Surest™ medical injectable policies to
align with UnitedHealthcare commercial plans policies.

Read Full Update Surest medical injectable policies to align with
UnitedHealthcare commercial plans policies

April 17, 2024


NORTH CAROLINA: GET ACCURATE RATES FOR NON-ROUTINE INFANT CARE



Learn when notification is required after rendering non-routine care to infants
and how noncompliance can affect your rate.

Read Full Update North Carolina: Get accurate rates for non-routine infant care

April 10, 2024


SUREST OUT-OF-NETWORK SERVICE AREA UPDATE



Beginning April 1, we’re updating the service area for Surest benefit plans with
out-of-network benefits.

Read Full Update Surest out-of-network service area update

March 13, 2024


UDENYCA ONBODY IS A PREFERRED PEGFILGRASTIM PRODUCT



Udenyca Onbody is a preferred pegfilgrastim product for UnitedHealthcare
commercial plans.

Read Full Update Udenyca Onbody is a preferred pegfilgrastim product

March 08, 2024


STREAMLINE PRIOR AUTHORIZATIONS WITH OUR CROSSWALK



Use our updated Prior Authorization Crosswalk to help determine next steps.

Read Full Update Streamline prior authorizations with our crosswalk

January 31, 2024


TEXAS MEDICAID: DME EXCEPTIONAL CIRCUMSTANCES PROVISION



Submit requests with prior authorizations for DME covered under the Home Health
Exceptional Circumstances Provision.

Read Full Update Texas Medicaid: DME exceptional circumstances provision



Expand All add_circle_outline
HOW DO I SUBMIT A PRIOR AUTHORIZATION, ADVANCE NOTIFICATION OR ADMISSION
NOTIFICATION?

expand_more

There are several ways you can submit prior authorizations, advance
notifications and admission notifications (HIPAA 278N):

 1. Prior authorization and notification tools: These digital options, available
    in the UnitedHealthcare Provider Portalopen_in_new, allow you to seamlessly
    submit your requests in real time
 2. EDI: This digital solution allows you to automate prior authorization and
    notification tasks
 3. Provider Services: If you’re unable to use the provider portal, call
    877‐842‐3210 to submit a request
 4. 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.




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