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
- 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
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