Advance Notification and Prior Authorization requirements
Health care professionals can view the following advance notification and prior authorization information or sign in to the UnitedHealthcare Provider Portal to help determine a member’s coverage.
Manage prior authorizations online
You can use the UnitedHealthcare Provider Portal to verify if a prior authorization is required. Check by member first to get the most accurate response, get a Decision ID and easily submit electronically if a prior authorization is required.
Current requirements by plan type
Choose one of the following relevant tabs to find the plan information you need.
Commercial
Surest
Mid-Atlantic Health Plans
Oxford Health Plans
UnitedHealthcare West
Neighborhood Health Partnership (NHP)
UnitedHealthcare of the River Valley
UnitedHealthcare Medicare Advantage, UnitedHealthcare west Medicare Advantage, UnitedHealthcare Dual Complete,
Peoples Health
Preferred Care Network
UnitedHealthcare Community Plan (Medicaid and long-term care)
Select your plan's state:
Individual Exchange
Individual Exchange behavioral health
- Alabama - effective Jan. 1, 2025
- Arizona - effective Jan. 1, 2025
- Colorado effective Jan. 1, 2025
- Florida - effective Jan. 1, 2025
- Georgia - effective Jan. 1, 2025
- Illinois - effective Jan. 1, 2025
- Kansas - effective Jan. 1, 2025
- Louisiana - effective Jan. 1, 2025
- Maryland - effective Jan. 1, 2025
- Michigan - effective Jan. 1, 2025
- Missouri - effective Jan. 1, 2025
- Mississippi - effective Jan. 1, 2025
- North Carolina - effective Jan. 1, 2025
- New Jersey - effective Jan. 1, 2025
- New Mexico - effective Jan. 1, 2025
- Ohio - effective Jan. 1, 2025
- Oklahoma - effective Jan. 1, 2025
- South Carolina - effective Jan. 1, 2025
- Tennessee - effective Jan. 1, 2025
- Texas - effective Jan. 1, 2025
- Virginia - effective Jan. 1, 2025
- Washington - effective Jan. 1, 2025
- Wisconsin - effective Jan. 1, 2025
- Commercial
- Medicare Advantage
- Community Plan (Medicaid)
- Individual Exchange
Commercial
Surest
Mid-Atlantic Health Plans
Oxford Health Plans
UnitedHealthcare West
Neighborhood Health Partnership (NHP)
UnitedHealthcare of the River Valley
UnitedHealthcare Medicare Advantage, UnitedHealthcare west Medicare Advantage, UnitedHealthcare Dual Complete,
Peoples Health
Preferred Care Network
UnitedHealthcare Community Plan (Medicaid and long-term care)
Select your plan's state:
Individual Exchange
Individual Exchange behavioral health
- Alabama - effective Jan. 1, 2025
- Arizona - effective Jan. 1, 2025
- Colorado effective Jan. 1, 2025
- Florida - effective Jan. 1, 2025
- Georgia - effective Jan. 1, 2025
- Illinois - effective Jan. 1, 2025
- Kansas - effective Jan. 1, 2025
- Louisiana - effective Jan. 1, 2025
- Maryland - effective Jan. 1, 2025
- Michigan - effective Jan. 1, 2025
- Missouri - effective Jan. 1, 2025
- Mississippi - effective Jan. 1, 2025
- North Carolina - effective Jan. 1, 2025
- New Jersey - effective Jan. 1, 2025
- New Mexico - effective Jan. 1, 2025
- Ohio - effective Jan. 1, 2025
- Oklahoma - effective Jan. 1, 2025
- South Carolina - effective Jan. 1, 2025
- Tennessee - effective Jan. 1, 2025
- Texas - effective Jan. 1, 2025
- Virginia - effective Jan. 1, 2025
- Washington - effective Jan. 1, 2025
- Wisconsin - effective Jan. 1, 2025
Previous requirements by plan type
Commercial
Commercial
- Effective Feb. 1, 2025
- Effective Jan. 1, 2025
- Effective Dec. 1, 2024
- Effective Nov. 1, 2024
- Effective Oct. 1, 2024
- Effective Aug. 1, 2024
- Effective July 1, 2024
- Effective May 1, 2024
- Effective April 1, 2024
- Effective March 1, 2024
- Effective Jan. 1, 2024
- Effective Nov. 1, 2023
- Effective Oct. 1, 2023
- Effective Sept. 1, 2023
- Effective July 1, 2023
- Effective June 1, 2023
- Effective May 1, 2023
- Effective April 1, 2023
Mid-Atlantic Health Plans
- Effective Feb. 1, 2025
- Effective Jan. 1, 2025
- Effective Dec. 1, 2024
- Effective Nov. 1, 2024
- Effective Oct. 1, 2024
- Effective Sept. 1, 2024
- Effective Aug. 1, 2024
- Effective July 1, 2024
- Effective May 1, 2024
- Effective April 1, 2024
- Effective March 1, 2024
- Effective Jan. 1, 2024
- Effective Dec. 1, 2023
- Effective Nov. 1, 2023
- Effective Oct. 1, 2023
- Effective Sept. 1, 2023
- Effective July 1, 2023
- Effective June 1, 2023
- Effective May 1, 2023
- Effective April 1, 2023
UnitedHealthcare of the River Valley
- Effective Feb. 1, 2025
- Effective Jan. 1, 2025
- Effective Dec. 1, 2024
- Effective Nov. 1, 2024
- Effective Oct. 1, 2024
- Effective Sept. 1, 2024
- Effective Aug. 1, 2024
- Effective July 1, 2024
- Effective May 1, 2024
- Effective April 1, 2024
- Effective March 1, 2024
- Effective Jan. 1, 2024
- Effective Dec. 1, 2023
- Effective Nov. 1, 2023
- Effective Oct. 1, 2023
- Effective Sept. 1, 2023
- Effective July 1, 2023
- Effective June 1, 2023
- Effective May 1, 2023
- Effective April 1, 2023
Oxford Health Plans
- Effective Feb. 1, 2025
- Effective Jan. 1, 2025
- Effective Dec. 1, 2024
- Effective Nov. 1, 2024
- Effective Oct. 1, 2024
- Effective Aug. 1, 2024
- Effective July 1, 2024
- Effective May 1, 2024
- Effective April 1, 2024
- Effective March 1, 2024
- Effective Jan. 1, 2024
- Effective Dec. 1, 2023
- Effective Nov. 1, 2023
- Effective Oct. 1, 2023
- Effective Sept. 1, 2023
- Effective July 1, 2023
- Effective June 1, 2023
- Effective May 1, 2023
- Effective April 1, 2023
Neighborhood Health Partnership (NHP)
- Effective Feb. 1, 2025
- Effective Jan. 1, 2025
- Effective Dec. 1, 2024
- Effective Nov. 1, 2024
- Effective Oct. 1, 2024
- Effective Aug. 1, 2024
- Effective July 1, 2024
- Effective May 1, 2024
- Effective April 1, 2024
- Effective March 1, 2024
- Effective Jan. 1, 2024
- Effective Dec. 1, 2023
- Effective Nov. 1, 2023
- Effective Oct. 1, 2023
- Effective Sept. 1, 2023
- Effective July 1, 2023
- Effective June 1, 2023
- Effective May 1, 2023
- Effective April 1, 2023
Medicare Advantage
UnitedHealthcare Medicare Advantage/ Peoples Health and Rocky Mountain Health Plans
- Effective Feb. 1, 2025
- Effective Jan. 1, 2025
- Effective Dec. 1, 2024
- Effective Nov. 1, 2024
- Effective Oct. 1, 2024
- Effective Sept. 1, 2024
- Effective July 1, 2024
- Effective June 1, 2024
- Effective May 1, 2024
- Effective April 1, 2024
- Effective March 1, 2024
- Effective Jan. 1, 2024
- Effective Nov. 1, 2023
- Effective Oct. 1, 2023
- Effective Sept. 1, 2023
- Effective Aug. 1, 2023
- Effective July 1, 2023
- Effective June 1, 2023
- Effective May 1, 2023
- Effective April 1, 2023
Preferred Care Network
- Effective Feb. 1, 2025
- Effective Jan. 1, 2025
- Effective Dec. 1, 2024
- Effective Nov. 1, 2024
- Effective Oct. 1, 2024
- Effective Sept. 1, 2024
- Effective July 1, 2024
- Effective June 1, 2024
- Effective May 1, 2024
- Effective April 1, 2024
- Effective March 1, 2024
- Effective Jan. 1, 2024
- Effective Nov. 1, 2023
- Effective Oct. 1, 2023
- Effective Sept. 1, 2023
- Effective Aug. 1, 2023
- Effective July 1, 2023
- Effective June 1, 2023
- Effective May 1, 2023
- Effective April 1, 2023
Behavioral Health Rocky Mountain Health Plans CareAdvantage Value, CareAdvantage Enhanced
Community Plan (Medicaid)
UnitedHealthcare Community Plan (Medicaid and long-term care)
Select your plan's state:
Individual Exchange
Individual Exchange behavioral health
2024
- Alabama - effective Jan. 1, 2024
- Arizona - effective Jan. 1, 2024
- Colorado - effective Jan. 1, 2024
- Florida - effective Jan. 1, 2024
- Georgia - effective Jan. 1, 2024
- Illinois - effective Jan. 1, 2024
- Kansas - effective Jan. 1, 2024
- Louisiana - effective Jan. 1, 2024
- Maryland - effective Jan. 1, 2024
- Michigan - effective Jan. 1, 2024
- Missouri - effective Jan. 1, 2024
- Mississippi - effective Jan. 1, 2024
- North Carolina - effective Jan. 1, 2024
- New Jersey - effective Jan. 1, 2024
- New Mexico - effective Jan. 1, 2024
- Ohio - effective Jan. 1, 2024
- Oklahoma - Effective Jan. 1, 2024
- South Carolina - effective Jan. 1, 2024
- Tennessee - effective Jan. 1, 2024
- Texas - effective Jan. 1, 2024
- Virginia - effective Jan. 1, 2024
- Washington - effective Jan. 1, 2024
- Wisconsin - effective Jan. 1, 2024
2023
- Alabama - effective Jan. 1, 2023
- Arizona - effective Jan. 1, 2023
- Colorado - effective Jan. 1, 2023
- Florida - effective Jan. 1, 2023
- Georgia - effective Jan. 1, 2023
- Illinois - effective Jan. 1, 2023
- Kansas - effective Jan. 1, 2023
- Louisiana - effective Jan. 1, 2023
- Maryland - effective Jan. 1, 2023
- Michigan - effective Jan. 1, 2023
- Missouri - effective Jan. 1, 2023
- Mississippi - effective Jan. 1, 2023
- North Carolina - effective Jan. 1, 2023
- Ohio - effective Jan. 1, 2023
- Oklahoma - effective Jan. 1, 2023
- Tennessee - effective Jan. 1, 2023
- Texas - effective Jan. 1, 2023
- Virginia - effective Jan. 1, 2023
- Washington - effective Jan. 1, 2023
Additional resources
- Crosswalk
- Prior authorization forms
- Commercial forms for drugs covered under the medical benefit
- Empire Plan: Durable Medical Equipment (DME) notification list