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.
Our commitment to simplifying prior authorizations
Learn more about our efforts to help reduce prior authorizations through our broad prior authorization reduction initiative, rural health prior authorization waiver program, rural payment acceleration program, pediatric prior authorization reductions and the National Gold Card Program.
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 comparison guide can help you choose which tools are right for you.
- UnitedHealthcare Provider Portal for online submission and status tracking
- Application Programming Interface offers real-time system-to-system integration
- Electronic Data Interchange for secure batch transaction processing
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.
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 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.
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
Prior authorization news
September 30, 2026
October monthly overview
Review the latest UnitedHealthcare prior authorization, medical policy, pharmacy, reimbursement, laboratory and policy and protocol updates for October 2026.
September 30, 2026
Medicare: Updated Part B step therapy prior authorization requirements
Starting Jan. 1, 2027, additional medications will require prior authorization as part of the Part B Step Therapy Program.
September 30, 2026
Medicaid: Prior auth reduction efforts expand to more states
Prior authorization reductions expand to more states. View the code list and changes effective Nov. 1 and Dec. 1.
September 30, 2026
Michigan: MCT2D CGM prior auth bypass pilot ending Jan. 1
On Jan. 1, 2027, the MCT2D prior auth bypass pilot program for continuous glucose monitors will end.
September 30, 2026
MH/SUD prior auth requests are moving to Provider Express
MH/SUD prior auth requests are moving to Provider Express; make sure your organization is connected.
September 30, 2026
Prior authorization reductions for members under 18
On Dec. 1, 2026, we’ll be reducing prior authorizations for members under the age of 18.
How do I submit a prior authorization, advance notification or admission notification?
There are several ways you can submit prior authorizations, advance notifications and admission notifications (HIPAA 278N):
- 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 877‐842‐3210 to submit a request
- 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.
Need help?
Connect with us through chat 24/7 in the UnitedHealthcare Provider Portal.