Individual and Family Plans: We’re easing administration burdens for some inpatient stays

To help reduce administrative burden, clinical review of inpatient behavioral health hospital admissions is no longer required until day 6 of a stay.

This change applies to:

Members covered by eligible UnitedHealthcare Individual and Family (Exchange) Plans*
New facility admissions or step-downs for dates of service on or after July 17, 2026

Action needed

Days 1–5: You’re still required to submit a prior authorization for these stays. This will be an administrative-only review. Clinical information will not be reviewed during the first 5 days.
Day 6: If the inpatient stay will extend beyond 5 days, clinical review is required. Please add clinical information to the prior authorization request in the Provider Express secure portal or by calling the number on the back of the member’s ID card.

Submit prior authorization requests as normal

Facilities may submit prior authorization requests in 2 ways:

Via the Provider Express secure portal (recommended)

By phone

Submitting electronically is the fastest way to complete your prior authorization request.

Sign in to the secure Provider Portal using a One Healthcare ID. Don’t have a One Healthcare ID? Register now.
From the Authorization menu select Review Online.
Search for member using member ID; eligibility will automatically align to the request.
Select Facility Address and choose Level of Care. Then proceed to Step 3.

Call the number on the back of the Member’s ID card.

Questions?

Connect with our AI Virtual Assistant 24/7. Simply, log in to the Provider Express secure portal with your One Healthcare ID.
Alternatively, you may call Provider Services at 1-877-614-0484, Monday – Friday, 7 a.m. – 7 p.m. CT

*UnitedHealthcare Individual Exchange plans are also referred to as UnitedHealthcare Individual & Family ACA Marketplace plans.

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