[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-287361-105":3,"detail-sidebar-cat-1-en-105":81,"doc-detail-287361-en":126},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","unitedhealthcare-medicare-advantage-prior-authorization-requirements-effective-march-1-2025","UnitedHealthcare Medicare Advantage - Prior Authorization Requirements - Effective March 1, 2025","","UnitedHealthcare Medicare Advantage prior authorization requirements effective March 1, 2025 define when participating providers must obtain approval for inpatient and outpatient services. The document covers requirements for UnitedHealthcare Dual Complete and other listed plans, and distinguishes excluded plans. It explains submission methods via provider portal or phone, clarifies that prior authorization is not needed for emergency or urgent care, and notes referral-based plan rules. It also outlines delegated prior authorization groups by state and lists Erickson Advantage services requiring prior authorization.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/template/","Template",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/template/letters/","Letters",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/template/unitedhealthcare-medicare-advantage-prior-authorization-requirements-effective-march-1-2025/287361/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/unitedhealthcare-medicare-advantage-prior-authorization-requirements-effective-march-1-2025/287361.png","ImageObject",442,249,{"name":42,"@type":43},"Taylor Morgan","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-09-26","2026-09-17",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",5,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"How can participating providers submit prior authorization requests?","Question",{"text":63,"@type":64},"Requests can be submitted online using the Prior Authorization and Notification tool on the UnitedHealthcare Provider Portal or by phone at 877-842-3210.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"When is prior authorization not required?",{"text":68,"@type":64},"Prior authorization is not required for emergency or urgent care.",{"name":70,"@type":61,"acceptedAnswer":71},"What happens if the member’s plan requires a referral?",{"text":72,"@type":64},"If the member’s ID card says “Referral Required,” certain services may need a referral from the primary care provider, and prior authorization must also be obtained from the treating physician.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},287361,1790204783,{"code":4,"msg":82,"data":83},"success",[84,89,94,99,104,109,114,118,122],{"id":85,"doc_module":22,"doc_module_name":25,"category_name":86,"show_sort_weight":87,"slug":88},11,"Presentations",90,"presentations",{"id":90,"doc_module":22,"doc_module_name":25,"category_name":91,"show_sort_weight":92,"slug":93},12,"Resumes",80,"resumes",{"id":95,"doc_module":22,"doc_module_name":25,"category_name":96,"show_sort_weight":97,"slug":98},14,"Invoices",70,"invoices",{"id":100,"doc_module":22,"doc_module_name":25,"category_name":101,"show_sort_weight":102,"slug":103},15,"Posters",60,"posters",{"id":105,"doc_module":22,"doc_module_name":25,"category_name":106,"show_sort_weight":107,"slug":108},16,"Social Media",50,"social-media",{"id":110,"doc_module":22,"doc_module_name":25,"category_name":111,"show_sort_weight":112,"slug":113},17,"Forms",40,"forms",{"id":115,"doc_module":22,"doc_module_name":25,"category_name":29,"show_sort_weight":116,"slug":117},18,30,"letters",{"id":119,"doc_module":22,"doc_module_name":25,"category_name":120,"show_sort_weight":55,"slug":121},21,"Paper Templates","papers-templates",{"id":123,"doc_module":22,"doc_module_name":25,"category_name":124,"show_sort_weight":4,"slug":125},158,"General","general-158",{"code":4,"msg":82,"data":127},{"doc_id":79,"user_id":128,"nickname":42,"user_avatar":129,"doc_module":22,"category_id":115,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":135,"language":136,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":12,"update_tm":140,"read_time":141},1099523885336,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","UnitedHealthcare Medicare Advantage/ Peoples Health and Rocky Mountain Health Plans prior authorization  \nrequirements  \neffective March 1, 2025  \nGeneral information  \nThis list contains prior authorization requirements for participating UnitedHealthcare Medicare Advantage healthcare professionals providing inpatient and outpatient services. This includes UnitedHealthcare Dual Complete® and other plans listed in the included plans section of this document. Health plans not included in the requirements are listed in the excluded plans section. Please submit your prior authorization requests in 1 of the following ways:  \n• Online: Use the Prior Authorization and Notification tool on UnitedHealthcare Provider Portal. To get started, go to [UHCprovider.com](UHCprovider.com) and click Sign In in the top-right corner to log in using your One Healthcare ID and password. Then, select the Prior Authorization and Notification tab on your dashboard. If you don’t have a One Healthcare ID, [visit](visit UHCprovider.com/access)[ UHCprovider.com/access](visit UHCprovider.com/access).  \n• Phone: Call 877-842-3210  \nPrior authorization is not required for emergency or urgent care.  \nNote: If you are a network health care professional who is contracted directly with a delegated medical  \ngroup/Independent Practice Association (IPA), then you must follow the delegate’s protocols. Delegates may use their own systems and forms. They must meet the same regulatory and accreditation requirements as UnitedHealthcare.  \nPlans with referral requirements: If a member’s health plan ID card says, Referral Required, certain services may require a referral from the member’s primary care provider. Prior authorization must also be obtained from the treating physician. See the 2025 UnitedHealthcare Care Provider Administrative Guide for more information. The following table includes plans requiring prior authorization for network services.  \nPlans included  \nMedicare plans subject to the UnitedHealthcare West Non-Capitated Supplement  \nMedicare Advantage HMO, HMO-POS, PPO and Regional PPO plans, including AARP® Medicare Advantage, UnitedHealthcare The Villages Medicare Advantage, UnitedHealthcare Group Medicare Advantage, Peoples Health  \nUnitedHealthcare Dual Complete (HMO D-SNP),(HMO-POS D-SNP),(PPO D-SNP),(Regional PPO D-SNP)  \nUnitedHealthcare Complete Care (HMO C-SNP),(HMO-POS C-SNP),(PPO C-SNP),(Regional PPO C-SNP)  \nUnitedHealthcare Nursing Home Plan and UnitedHealthcare Care Advantage (HMO I-SNP),(HMO-POS I-SNP),(PPO I-SNP)  \nErickson Advantage: Prior authorization is required on the following select set of services:  \n1. DME with expense greater than $1,000  \n2. All out of network services when member requests coverage at in-network rates  \n3. Elective inpatient hospitalizations  \n4. Outpatient physical, speech and occupational therapy to members residing in long-term care facilities  \n5. Admission to non-Erickson home health care  \n6. Admission to a non-Erickson skilled nursing facility  \n7. Routine transportation  \n8. Experimental and investigational services  \n9. Potential cosmetic services  \n10. Transplants  \nUnitedHealthcare Dual Eligible Special Needs Plans (D-SNP) and Medicare Advantage benefit plans offered by UnitedHealthcare Community Plan are subject to an additional manual, as further described in the benefit plan section of the 2025 UnitedHealthcare Care Provider Administrative Guide. As explained in the benefit plan section, some UnitedHealthcare D-SNP and Medicare Advantage benefit plans offered by UnitedHealthcare Community Plan are not subject to an additional manual and are therefore subject to the administrative guide.  \nIn some instances, we have delegated prior authorization services to a care provider group. In these cases, the For Providers section on the back of the member’s ID card will list the delegated group managing the prior authorization process. These following plans are included.  \nDelegated plans  \nArizona  \nThe follo","cbCair1D1PzosXoa","https://ap.wps.com/l/cbCair1D1PzosXoa","pdf",574861,27,"English","# General information\n## Submission methods\n## Emergency and urgent care\n## Delegate and referral requirements\n# Plans included and excluded\n## Plans requiring prior authorization\n## Erickson Advantage services\n# UnitedHealthcare Dual Eligible and Community Plan\n# Delegated plans by state","[{\"question\":\"How can participating providers submit prior authorization requests?\",\"answer\":\"Requests can be submitted online using the Prior Authorization and Notification tool on the UnitedHealthcare Provider Portal or by phone at 877-842-3210.\"},{\"question\":\"When is prior authorization not required?\",\"answer\":\"Prior authorization is not required for emergency or urgent care.\"},{\"question\":\"What happens if the member’s plan requires a referral?\",\"answer\":\"If the member’s ID card says “Referral Required,” certain services may need a referral from the primary care provider, and prior authorization must also be obtained from the treating physician.\"}]","UnitedHealthcare Medicare Advantage - Prior Authorization Requirements - Effective March 1, 2025 | PDF",1789632202,9]