UnitedHealthcare · JSON Structure

Provider Prior Auth Check Request Structure

Request to check prior authorization requirements for a procedure

Type: object Properties: 0
Health InsuranceHealthcareFHIRClaimsEligibility

UnitedHealthcare Prior Auth Check Request is a JSON Structure definition published by UnitedHealthcare. It conforms to the https://json-structure.org/meta/core/v0/# meta-schema.

Meta-schema: https://json-structure.org/meta/core/v0/#

JSON Structure

Raw ↑ 
{
  "$schema": "https://json-structure.org/meta/core/v0/#",
  "$id": "https://raw.githubusercontent.com/api-evangelist/unitedhealthcare/refs/heads/main/json-structure/provider-prior-auth-check-request-structure.json",
  "name": "UnitedHealthcare Prior Auth Check Request",
  "type": "object",
  "description": "Request to check prior authorization requirements for a procedure",
  "fields": [
    {
      "name": "memberId",
      "type": "string",
      "description": "Member ID"
    },
    {
      "name": "npi",
      "type": "string",
      "description": "Provider NPI"
    },
    {
      "name": "serviceCode",
      "type": "string",
      "description": "CPT/HCPCS service code"
    },
    {
      "name": "serviceType",
      "type": "string",
      "description": "Service type description"
    },
    {
      "name": "dateOfService",
      "type": "date",
      "description": "Planned date of service"
    },
    {
      "name": "diagnosisCodes",
      "type": "array",
      "description": "ICD-10 codes",
      "items": {
        "type": "string"
      }
    },
    {
      "name": "placeOfService",
      "type": "string",
      "description": "Place of service code"
    }
  ]
}