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   List of contracted, high-quality independent lab providers
   
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   Update, verify and attest to your practice's demographic data
   
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   Provider search for doctors, clinics and facilities, plus dental and
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 1. Home
 2. Eligibility and Referrals

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February 26, 2024 at 8:00 AM CT

If you are experiencing connectivity issues with UnitedHealthcare, please use
our secure self-service options in the UnitedHealthcare Provider Portal or an
existing API connection. The portal is currently available to check eligibility,
manage claim reconsiderations and appeals, and submit prior authorization
requests.




ELIGIBILITY AND REFERRALS

Eligibility benefits and referral information for health care providers. Verify
patient eligibility, determine benefits, and check or manage health care
provider referrals. 

Based on health plan requirements, health care professionals can use
UnitedHealthcare digital tools to check eligibility and determine if a prior
authorization, notification or referral is required.


ARE YOU A MEMBER LOOKING FOR A PROVIDER?

Find in-network providers at myuhc.comopen_in_new.




VERIFY ELIGIBILITY AND REQUEST REFERRALS DIGITALLY

We offer several digital tools to help health care professionals manage
eligibility and referral activity. The digital solutions comparison
guideopen_in_new can help health care professionals choose which tools are right
for them.  

UNITEDHEALTHCARE PROVIDER PORTAL

The secure place for accessing patient and practice-specific information
including checking eligibility and referral requirements. Sign inopen_in_new to
the Provider Portal to begin.




APPLICATION PROGRAMMING INTERFACE

Application Programming Interface (API) is a common interface that interacts
between multiple applications in real-time. API solutions allow health care
professionals to electronically receive detailed data on the status of claims,
eligibility and benefits. Explore the benefits of API or download the
overviewopen_in_new. The API marketplaceopen_in_new houses API technical
guides. 



ELECTRONIC DATA INTERCHANGE

Electronic Data Interchange (EDI) is the automated transfer of data. This
involves enabling seamless and faster information transfers by allowing health
care professionals or facilities to check eligibility and benefits. The EDI
overviewopen_in_new highlights the benefits of this technology.


Expand All add_circle_outline
Supporting tools
expand_more

Individual Health Record
A digital tool that shares individual health records in near-real time to help
improve collaboration and care. View the individual health record details. 

Point of Care Assist
Point of Care Assist® adds real-time patient information to existing electronic
medical records (EMRs) to make it easier to understand a patient’s needs. Point
of Care Assist includes the following patient information:

 * Clinical
 * Pharmacy labs
 * Eligibility
 * Prior authorization
 * Specialty search
 * Costs

PreCheck MyScript
PreCheck MyScript integrates directly with an EMR, and is available in the
Provider Portal, allowing health care professionals to easily run a pharmacy
trial claim and get real-time prescription coverage details. Explore the
benefits and features.

Designated diagnostic provider
A new UnitedHealthcare commercial plan benefit for lab and major imaging
services at lower rates, available in approved states, when using an approved
designated diagnostic provider. Refer a member or apply to become an approved
designated diagnostic provider.

Coordination of care
A way for health care professionals to collaborate and integrate a member’s
physical and behavioral health needs. Our helpful tools and resources support
this coordination.







PRIOR AUTHORIZATION

Sometimes, health care professionals need to determine if UnitedHealthcare
covers certain services and receiving notifications is often an important step
in that process. Our prior authorization digital tools can help health care
professionals seamlessly submit and verify prior authorizations and advance
notifications in real-time. To check the status of previously submitted
authorizations and notifications use (278I) inquiry. 




EDUCATION & TRAINING

   
   
 * UnitedHealthcare Provider Portal trainingopen_in_new
   
 * Eligibility and benefits interactive guideopen_in_new
 * Referrals interactive guideopen_in_new
 * API interactive user guideopen_in_new
 * What is EDIopen_in_new and EDI connectivityopen_in_new
 * Individual Health Record interactive guideopen_in_new
 * Point of Care Assist®open_in_new


ADDITIONAL RESOURCES

Behavioral Health Resources
These resources can help health care professionals screen patients for
depression, attention deficit hyperactivity disorder (ADHD) and
alcohol/substance misuse.

Cancer therapy pathways program
The program is intended to improve quality and value in cancer care by
supporting the use of therapies supported by evidence-based guidelines to
improve outcomes.

Cancer support program
This program focuses on supporting cancer patients who are at high risk for
complications and side effects associated with their cancer or treatment and
would benefit from the support of our experienced, specialized cancer nurses.




NEED HELP?

Chat with us 7 a.m.–7 p.m. CT, Monday – Friday from the UnitedHealthcare
Provider Portal. 

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