Advance Notification and Plan Requirement Resources
Advance notification is the first step in UnitedHealthcare’s process to determine coverage for a member. Certain services and plans require advance notification so we can determine if they are medically necessary and covered by the member’s plan. We also use the information you submit for case and condition management program referrals. The services that require advance notification are specified in the Plan Requirement documents below.
When you provide us with advance notification, we’ll let you know if prior authorization is needed for the service to be covered. If prior authorization is required, we’ll also tell you what information we need and help you work through the process.
It’s very important that you follow all plan requirements so we can help you get claims paid. Missing requirements may result in claims being denied in whole or in part. If that’s the case, the member cannot be billed for those denied services.
Predeterminations are requests that services or treatments be approved before they have been received (also known as preservice claim determinations). If you would like to request a Predetermination, please fill the below form and attach it to your UnitedHealthcare Provider Portal submission with supporting clinical. The specifics on supporting clinical can be found under the Prior Authorization and Notification section of this website. Or you can fax the form and clinical to 845-249-2932.