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Prior authorization and notification

We have online tools and resources to help you manage your practice’s notification and prior authorization requests.

To submit and manage your prior authorizations, please sign in to the UnitedHealthcare Provider Portal. You can find additional information on our prior authorization page. 

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Prior authorization policies

UnitedHealthcare Community Plan of Texas annually reviews our health plan prior authorization policies in accordance with Texas Government Code Section §533.00283. The policies are normally reviewed each October for the previous Texas Health and Human Services fiscal year (Sept. 1 – Aug. 31). For more information, please call 888-887-9003.

Medical necessity supporting documentation


Some prior authorization requests require documentation in addition to the prior authorization form to support a determination of medical necessity. To see which documentation is necessary for a prior authorization request, go to:

Submitting additional supporting documentation

  • If a prior authorization request lacks the necessary information to determine medical necessity, we will send a letter describing the documentation that needs to be submitted to the member and the requesting provider within 3 business days from receipt of the request. The notification will include applicable time frames for the provider to submit the requested information.
  • When possible, we will also contact the requesting provider by phone to obtain the information necessary to complete the prior authorization process
  • If the information is not provided within 3 business days of our request for additional information, the request may be denied. A preemptive physician review between our medical director and the requesting physician will occur before the request is denied.
  • If we receive the requested information, we will review the request within 3 business days.
  • Please submit prior authorization requests and supporting documentation through the UnitedHealthcare Provider Portal or by faxing to 877-940-1972.
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Care decisions are based on medical necessity in accordance with care guidelines developed by both UnitedHealthcare and the Texas Health and Human Services Commission. Services must be outcome-driven, clinically necessary, evidence-based and provided in the least restrictive environment possible. We don’t reward our staff or providers for issuing denials of coverage for service care. Utilization management decision-makers don’t receive financial or other incentives that encourage decisions resulting in under utilization of services.

Emergency medical conditions and emergency behavioral health conditions do not require prior authorization.

In order to initiate a prior authorization request, the following essential information (EI) is required:

  • Member name
  • Member number or Medicaid number
  • Member date of birth
  • Requesting provider’s name
  • Requesting provider’s National Provider Identifier (NPI)
  • Rendering provider’s name
  • Rendering provider’s National Provider Identifier (NPI)
  • Rendering provider's tax ID number (TIN)
  • Service requested: Use CPT®, HCPCS or CDT, as appropriate
  • Service requested start and end dates
  • Quantity of service units requested based on the CPT, HCPCS, or CDT requested

If a prior authorization request does not contain each of the essential information data points, the request will not be created and will be returned to the provider with guidance on which information is missing.

NOTE: Please ensure all required clinical documentation is included to avoid delays in service for our shared members.

UnitedHealthcare Community Plan - Children's Health Insurance Program (CHIP)
UnitedHealthcare Community Plan - Connected Texas (Medicare-Medicaid Plan)
UnitedHealthcare Community Plan - STAR
UnitedHealthcare Community Plan - STAR Kids
UnitedHealthcare Community Plan - STAR+PLUS

Need more help?

Prior authorization questions: Please call Customer Service at 888-887-9003, Monday–Friday, 8 a.m.–6 p.m. CT.

Check the status of an existing prior authorization 24/7 by using the Prior Authorization and Notification tool found in the UnitedHealthcare Provider Portal or calling Clinical Authorization Services 24/7 at 888-887-9003.

Pharmacy prior authorization questions: Please visit the Pharmacy Resources section or call our Pharmacy Help Desk at 800-310-6826, Monday–Friday, 7 a.m.–7 p.m. CT (voicemail intake is available after hours).

Patient prior authorization requirement questions for UnitedHealthcare Community Plan members: They can call Member Services at one of the following numbers, Monday–Friday, 8 a.m.–6 p.m. CT:

  • STAR+PLUS, STAR and CHIP: 888-887-9003
  • STAR Kids: 877-597-7799
  • UnitedHealthcare Connected (Medicare-Medicaid Plan): 800-256-6533

CPT® is a registered trademark of the American Medical Association.