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.
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.
Modernizing the prior authorization process, this program is available for provider groups meeting eligibility requirements.
UnitedHealthcare Provider Portal – The Prior Authorization and Notification tool allows you to submit inquiries, process requests and get status updates.
Electronic Data Interchange (EDI) allows you to securely and electronically submit and receive batch transactions for multiple cases.
PreCheck MyScript® integrates directly within your EMR so you can easily run a pharmacy trial claim and get real-time prescription coverage details.
Sign in to use PreCheck MyScript.
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 Crosswalk information sheet.
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 requests
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.
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.