Search

July 18, 2024

Texas Medicaid: Help avoid service delays

Submit any required medical necessity documentation with prior authorization requests

As you know, some prior authorization requests require clinical documentation to support a medical necessity determination. This documentation must be submitted along with the prior authorization form.

Supporting documentation requirements are based on clinical criteria in UnitedHealthcare medical policies and guidance from UnitedHealthcare physicians and pharmacists with experience in reviewing service requests for coverage. Additionally, some requirements for supporting documentation are determined by the Texas Health and Human Services Commission.

For example, supporting documentation is needed if a provider requests a magnetic resonance imaging (MRI) screening in an outpatient hospital. In those cases, a provider also is required to submit medical notes documenting:

  • The patient’s recent history
  • A physical examination, including patient weight
  • Patient condition, allergy, chronic disease and surgical plan
  • Other specific criteria (see coverage rationale) that qualifies the individual for the site of service requested

Resources

View the resources below for more information on which documentation is necessary for a prior authorization request.

How to submit a request

You can submit a prior authorization request through the UnitedHealthcare Provider Portal:

  • Go to UHCprovider.com and click Sign In at the top-right corner
  • Enter your One Healthcare ID and password
  • In the menu, select Prior Authorizations 
  • Scroll down to “Create a new notification or prior authorization request” and select Create New Submissions
  • Enter the required information and submit

Questions? We're here to help

Connect with us through chat 24/7 in the UnitedHealthcare Provider Portal. For additional contact information, visit our Contact us page.

PCA-1-24-01864-Clinical-NN_06282024

Finding news icon

Discover more news

Personalized news icon

Get personalized news