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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.
Easily access and download all UnitedHealthcare provider-forms in one convenient location. The UnitedHealthcare Provider Portal allows you to submit referrals, prior authorizations, claims, claim reconsideration and appeals, demographic changes and more.
Prior Authorization Request Form. Please complete this entire form and fax it to: 866-940-7328. If you have questions, please call 800-310-6826. This form may contain multiple pages. Please complete all pages to avoid a delay in our decision. Allow at least 24 hours for review. Member Information.
Please use the forms below to request prior authorization for drugs covered under the medical benefit. For forms to request prior authorization for drugs covered under the retail pharmacy benefit, please visit the OptumRx Healthcare Professionals Portal .
Prior authorization and notification for radiology and diagnostic imaging procedures. Learn about the requirements, process, and specific radiology programs.
Beginning September 1, 2015, health benefit plan issuers must accept the Texas Standard Prior Authorization Request Form for Health Care Services if the plan requires prior authorization of a health care service.
Your patient’s benefit plan requires that we review certain requests for coverage with the prescribing physician. This includes requests for benefit coverage beyond plan specifications. Please complete the following questions and then fax this form to the toll free number listed below.
Provider - ePA saves administrative time by making it easier to submit and track prior authorizations, and enables faster turnaround of coverage determinations. If you cannot submit requests through ePA, please select a state from the left side list for a current list of prior authorization forms.
If your search does not yield a result, please use this Prior Authorization Request form. open_in_new. Maryland Community Plan healthcare providers should use these prior authorization forms when requesting specific drugs. Learn more or submit a form today.
To provide notification/request prior authorization, please submit your request online or by phone: Online: Use the Prior Authorization and Notification tool on UnitedHealthcare Provider Portal.