Fax number for united healthcare prior authorization

Updated January 24, 2022

A UnitedHealthcare prior authorization form is used by physicians in the instances they need to prescribe a medication that isn’t on the preferred drug list (PDL). Person’s covered under a UnitedHealthcare Community Plan (UHC) have access to a wide range of prescription medication. The purpose of this form is to demonstrate medical justification for prescribing the drug in question when other drugs on the PDL might serve the same purpose. The form should be submitted to UHC where they will review the physician’s medical reasoning and either approve or deny the prescription. If the request is denied, the patient may choose to pay for the drug out of pocket or ask the physician to prescribe a similar drug from the PDL.

Form can be faxed to: 1 (866) 940-7328

Phone number: 1 (800) 310-6826

Preferred Drug List

How to Write

Step 1 – Enter today’s date at the top of the page.

Step 2 – “Section A” must be completed with the patient’s information. Include the patient’s full name, member ID, address, phone number, DOB, allergies, primary insurance, policy number, and group number.

Step 3 – Select the “NEW” box if the medication has not been prescribed before or select the “CONTINUATION” box if this is a renewal request. If the second box was checked, enter the start date. If the patient is currently hospitalized, select “YES” otherwise select “NO”.

Step 4 – In the “Physician Information” section, enter the physician’s full name, address, phone number, fax number, NPI number, specialty, and office contact name.

Step 5 – Under “Medical Information”, enter the name of the requested drug, the strength, and the directions of use. Be sure to include the diagnosis and the appropriate ICD codes.

Step 6 – If the patient is pregnant, you must disclose this information and include their due date.

Step 7 – Next, a space is provided for the physician to include their medical reasoning as to why this particular drug must be prescribed over other medication options.

Step 8 – Under “Other Medications Tried”, enter the name, strength, directions, dates of therapy, and reason for discontinuation of all medications that were previously prescribed to the patient to treat their condition.

Specialty specific resources

Frequently searched

Prior Authorization Crosswalk and Prior Authorization Crosswalk Information Sheet
Use the Prior Authorization Crosswalk Table when you have an approved prior authorization for treating a UnitedHealthcare commercial member and need to provide an additional or different service. The table will help you determine if you can use the approved prior authorization, modify the original or request a new one.

Peer to Peer Scheduling Request
Peer to peer requests can only be made prior to submitting an appeal. Don’t fill out this form if your appeal has already been initiated.

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.

Submitting Admission Notification, Prior Authorization Requests and Advance Notification
Information about active fax numbers used for medical prior authorization.

Prior Authorization and Notification Program Summary
This page includes a summary of the Prior Authorization and Notification Program, and is not meant to be comprehensive. Please refer to the UnitedHealthcare Administrative Guide for program details and required protocols.

Admission Notification Fax Numbers
You can begin to transition all your admission notifications to an electronic channel today.

We've Retired Fax Numbers Used for Medical Prior Authorization Requests
Information about retiring fax numbers used for medical prior authorization.

Prior Authorization Utilization Review Statistics
Prior Authorization Utilization Review Statistics information is provided to comply with a regulatory requirement for states that require disclosure of information for services that require pre-service review.

Drug Lists and Pharmacy
Information related to pharmacy coverage decisions based on an understanding of how health plan coverage affects total member health care including drug lists, supply limits, step therapy, and infusion care.

Cancer Therapy Pathways Program
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Community Plan Pharmacy Prior Authorization for Prescribers
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