www.uhcprovider.com
Open in
urlscan Pro
2620:1ec:bdf::45
Public Scan
URL:
https://www.uhcprovider.com/en/prior-auth-advance-notification.html
Submission: On July 02 via manual from US — Scanned from DE
Submission: On July 02 via manual from US — Scanned from DE
Form analysis
3 forms found in the DOM<form style="display: flex; position: relative;">
<div id="searchErrorMessage" class="input-search-error error" style="visibility: hidden;"></div><label class="sr-only" for="megamenu-search-mobile">Search</label><input id="megamenu-search-mobile" class="megamenu-search" type="text"
aria-label="search" placeholder="Search" value="" style="height: 2.25rem; border-radius: 0.25rem; border: 0.0625rem solid rgb(51, 51, 51); padding-right: 1.5rem; padding-left: 10px; width: 100%;">
<div style="color: rgb(0, 38, 119); position: absolute; right: 0.5rem; top: 0.55rem; cursor: pointer;">
<div class="material-icons">search</div>
</div>
</form>
<form style="display: flex; position: relative;">
<div id="searchErrorMessage" class="input-search-error error" style="visibility: hidden;"></div><label class="sr-only" for="megamenu-search-desktop">Search</label><input id="megamenu-search-desktop" class="megamenu-search" type="text"
aria-label="search" placeholder="Search" value="" style="height: 2.25rem; border-radius: 0.25rem; border: 0.0625rem solid rgb(51, 51, 51); padding-right: 1.5rem; padding-left: 10px; width: 100%;">
<div style="color: rgb(0, 38, 119); position: absolute; right: 0.5rem; top: 0.55rem; cursor: pointer;">
<div class="material-icons">search</div>
</div>
</form>
<form style="display: flex; position: relative;">
<div id="searchErrorMessage" class="input-search-error error" style="visibility: hidden;"></div><label class="sr-only" for="megamenu-search-tablet">Search</label><input id="megamenu-search-tablet" class="megamenu-search" type="text"
aria-label="search" placeholder="Search" value="" style="height: 2.25rem; border-radius: 0.25rem; border: 0.0625rem solid rgb(51, 51, 51); padding-right: 1.5rem; padding-left: 10px; width: 100%;">
<div style="color: rgb(0, 38, 119); position: absolute; right: 0.5rem; top: 0.55rem; cursor: pointer;">
<div class="material-icons">search</div>
</div>
</form>
Text Content
SEARCH close Search search close Close MENU * SIGN IN * Sign in to the UnitedHealthcare Provider Portal * New User & User Access Need access to the UnitedHealthcare Provider Portal? * MAIN MENU * Eligibility and Referrals * Prior Authorization * Claims and Payments * OUR NETWORK * Join our network * Contact us * Preferred Lab Network * Demographics and profiles * Find a provider * RESOURCES * Health plans, policies, protocols and guides * Administrative guides and manuals * Drug lists and pharmacy * Health plans * Education and training * Reports and quality programs * Forms * News * Resource library * The UnitedHealthcare Provider Portal resources * * Membersopen_in_new * New User & User Access Skip to main content * Membersopen_in_new * New User & User Access Search search menu MENU Search search * * Eligibility and Referrals * * * Prior Authorization * * * Claims and Payments * * * Our network expand_more * Join our network Steps to getting contracted plus plan information Contact us Phone numbers and links for connecting with us Preferred Lab Network List of contracted, high-quality independent lab providers Demographics and profiles Update, verify and attest to your practice's demographic data Find a provider Provider search for doctors, clinics and facilities, plus dental and behavioral health * * Resources expand_more * Health plans, policies, protocols and guides Policies for most plan types, plus protocols, guidelines and credentialing information Administrative guides and manuals Drug lists and pharmacy Pharmacy resources, tools, and references Health plans View health plans available by state Choose a location Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Choosing a location will immediately redirect Education and training Updates and getting started with our range of tools and programs Reports and quality programs Reports and programs for operational efficiency and member support Forms News Important news updates for you Resource library Tools, references and guides for supporting your practice The UnitedHealthcare Provider Portal resources Log in for our suite of tools to assist you in caring for your patients * * * Sign Inexpand_more * Sign in to the UnitedHealthcare Provider Portal * Need access to the UnitedHealthcare Provider Portal? New User & User Access search 1. Home 2. Prior Authorization and Notification print Print add_alert For information on the Change Healthcare cyber responseopen_in_new 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. DIGITAL TOOLS 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. MEDICAL PROFESSIONAL DIGITAL TOOLS UnitedHealthcare Provider Portal – The Prior Authorization and Notification tool allows you to submit inquiries, process requests and get status updates. Sign inopen_in_new to the portal * Prior Authorization and Notification quick start guideopen_in_new * Prior Authorization and Notification interactive guideopen_in_new Electronic Data Interchange (EDI) allows you to securely and electronically submit and receive batch transactions for multiple cases. PHARMACY DIGITAL TOOLS PreCheck MyScript® integrates directly within your EMR so you can easily run a pharmacy trial claim and get real-time prescription coverage details. Sign inopen_in_new to use PreCheck MyScript. MEDICAL PROFESSIONAL RESOURCES Crosswalkopen_in_new 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 sheetopen_in_new. 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 requestsopen_in_new 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. 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. 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 See all news arrow_forward June 28, 2024 MICHIGAN: PRIOR AUTHORIZATION UPDATES FOR PROVIDER ADMINISTERED MEDICATIONS Starting Oct. 1, 2024, we’ll require prior authorization for some provider administered medications in Michigan. Read Full Update Michigan: Prior authorization updates for provider administered medications June 28, 2024 MASSACHUSETTS MEDICAID: USE APPROPRIATE BILLING CODES FOR FASTER DME CLAIMS PROCESSING Correct billing code information for power wheelchair repairs for UnitedHealthcare Community Plan of Massachusetts plan members. Read Full Update Massachusetts Medicaid: Use appropriate billing codes for faster DME claims processing June 28, 2024 UPDATES TO ONCOLOGY AND HEMATOLOGY PRIOR AUTHORIZATION CODES FOR MANY PLANS Starting Oct. 1, 2024, we’ll require prior authorization for diagnosis of oncologic or hematologic conditions. Read Full Update Updates to oncology and hematology prior authorization codes for many plans June 28, 2024 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 June 28, 2024 NEW PRIOR AUTHORIZATION REQUIREMENTS FOR CGMS As of Sept. 1, we’re making updates to continuous glucose monitor coverage for UnitedHealthcare Medicare Advantage plans. Read Full Update New prior authorization requirements for CGMs June 28, 2024 NEW ONLINE UTILIZATION MANAGEMENT REQUIREMENT You will be required to submit utilization management requests online for patients delegated to Optum Health Networks. Read Full Update New online utilization management requirement Expand All add_circle_outline HOW DO I SUBMIT A PRIOR AUTHORIZATION, ADVANCE NOTIFICATION OR ADMISSION NOTIFICATION? expand_more There are several ways you can submit prior authorizations, advance notifications and admission notifications (HIPAA 278N): 1. Prior authorization and notification tools: These digital options, available in the UnitedHealthcare Provider Portalopen_in_new, allow you to seamlessly submit your requests in real time 2. EDI: This digital solution allows you to automate prior authorization and notification tasks 3. Provider Services: If you’re unable to use the provider portal, call 877‐842‐3210 to submit a request 4. 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.open_in_new Did you find what you were looking for? YesNo * About usopen_in_new * Contact us * Careersopen_in_new * Find a provider © 2024 UnitedHealthcare | All Rights Reserved Fraud, waste and abuseopen_in_new Language assistanceopen_in_new Privacyopen_in_new Sitemap Terms of useopen_in_new Feedback