UnitedHealthcare Prior Auth Check Request

Request to check prior authorization requirements for a procedure

Health InsuranceHealthcareFHIRClaimsEligibility

Properties

Name	Type	Description
memberId	string	Member ID
npi	string	Provider NPI
serviceCode	string	CPT/HCPCS service code
serviceType	string	Service type description
dateOfService	string	Planned date of service
diagnosisCodes	array	ICD-10 codes
placeOfService	string	Place of service code

View JSON Schema on GitHub

JSON Schema

{
  "$schema": "https://json-schema.org/draft/2020-12/schema",
  "$id": "https://raw.githubusercontent.com/api-evangelist/unitedhealthcare/refs/heads/main/json-schema/provider-prior-auth-check-request-schema.json",
  "title": "UnitedHealthcare Prior Auth Check Request",
  "description": "Request to check prior authorization requirements for a procedure",
  "type": "object",
  "required": [
    "memberId",
    "npi",
    "serviceCode"
  ],
  "properties": {
    "memberId": {
      "type": "string",
      "description": "Member ID"
    },
    "npi": {
      "type": "string",
      "description": "Provider NPI"
    },
    "serviceCode": {
      "type": "string",
      "description": "CPT/HCPCS service code"
    },
    "serviceType": {
      "type": "string",
      "description": "Service type description"
    },
    "dateOfService": {
      "type": "string",
      "format": "date",
      "description": "Planned date of service"
    },
    "diagnosisCodes": {
      "type": "array",
      "items": {
        "type": "string"
      },
      "description": "ICD-10 codes"
    },
    "placeOfService": {
      "type": "string",
      "description": "Place of service code"
    }
  }
}

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