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.
For UnitedHealthcare Community Plan, please visit our Health Plans by State section and select the appropriate state, then Community Plan to view current lists.
For UnitedHealthcare Special Needs Plans, view the Medicare Advantage requirement list found lower on this page.