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.
Our National Gold Card program
Modernizing the prior authorization process, this program is available for provider groups meeting eligibility requirements.
Get the details
Digital tools
We’ve designed our digital tools to help you seamlessly submit and verify your prior authorizations and advance notifications in real time. The digital solutions comparisonguidecan help health care professionals choose which tools are right for them.
UnitedHealthcare Provider Portal
The Prior Authorization and Notification tool allows you to submit inquiries, process requests and get status updates online. Access our quick start guide or interactive guide to learn more.
Sign in
Application Programming Interface
Application Programming Interface (API) is a common interface that interacts between multiple applications in real time.API status check is now available for prior authorization.
Explore API
Electronic Data Interchange
Electronic Data Interchange (EDI)allows you to securely and electronically submit and receive batch transactions for multiple cases.
Learn more
Medical professional resources
Crosswalk
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 Crosswalkinformation sheet.
Advance notification and prior authorization requirements
This is the first step in determining coverage based on medical necessity. Prior authorization may still be required.
Regulatory
You can find state-required information regarding services that require pre-service review.
Pre-service appeals and peer-to-peer requests
Access options for submitting either a pre-service appeal or a peer-to-peer request electronically.
Pharmacy resources
Clinical and specialty pharmacy
Certain medications require notification and review to determine coverage under pharmacy benefits.You can view clinical pharmacy requirementshere.
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.
PreCheck MyScript®
A real-time benefit check tool available through the UnitedHealthcare Provider Portal that allows prescribers to easily run a pharmacy trial claim and get prescription coverage detail.
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
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May 13, 2025
Outpatient therapy and chiropractic prior authorization requirements
UnitedHealthcare Medicare Advantage plans nationally will require prior authorization for outpatient therapy and chiropractic services.
Read Full Update Outpatient therapy and chiropractic prior authorization requirements
April 09, 2025
Medicare: Part B step therapy prior authorization requirements
For dates of service starting Jan. 1, 2025, prior authorization is required for Part B Step Therapy Program medications.
Read Full Update Medicare: Part B step therapy prior authorization requirements
March 28, 2025
Arizona: No referrals required with HMO Open Access
As of Jan. 1, 2024, all of our Medicare HMO H0609 plans no longer require referrals.
Read Full Update Arizona: No referrals required with HMO Open Access
March 10, 2025
Verify address to avoid APWUHP claim appeal delays
Claim appeals addressed incorrectly may be delayed or go unanswered. And APWUHP members to be assigned a new group number.
Read Full Update Verify address to avoid APWUHP claim appeal delays
March 07, 2025
Home health and private duty nursing services prior authorization process
Home health and private duty nursing service prior authorization requests are assessed based on medical necessity and more.
Read Full Update Home health and private duty nursing services prior authorization process
January 27, 2025
Updates to pharmacy prior authorization and step therapy requirements
Effective Jan. 1, 2025, Optum Rx will manage pharmacy prior authorizations and step therapy requests for Golden Rule plans.
Read Full Update Updates to pharmacy prior authorization and step therapy requirements
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How do I submit a prior authorization, advance notification or admission notification?
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There are several ways you can submit prior authorizations, advance notifications and admission notifications (HIPAA278N):
- Prior authorization and notification tools: These digital options, available in the UnitedHealthcare Provider Portal, allow you to seamlessly submit your requests in real time
- EDI: This digital solution allows you to automate prior authorization and notification tasks
- Provider Services: If you’re unable to use the provider portal, call 877‐842‐3210to submit a request
- Fax: You can submit requests by fax to855‐352‐1206. Please note: This option is only available for the following commercial plans: Massachusetts, Nevada, New Mexico and Texas.
Need help?
Connect with us through chat 24/7 in theUnitedHealthcare Provider Portal.
