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.
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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 guide 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 in 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 overview. The API marketplace 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 overview highlights the benefits of this technology.
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 training
- Eligibility and benefits interactive guide
- Referrals interactive guide
- API interactive user guide
- What is EDI and EDI connectivity
- Individual Health Record interactive guide
- Point of Care Assist®
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?
Connect with us through chat 24/7 in the UnitedHealthcare Provider Portal.