guide
UMR prior authorization: how to check each plan's requirements
UMR prior authorization follows the employer’s plan, not one list for every UMR patient. UMR is UnitedHealthcare’s third-party administrator for self-funded employer plans, and it serves more than 3,800 benefit plans and their 6 million members, according to UMR. Each of those plans sets its own requirements.
So the first step for any UMR patient is a plan-specific lookup in UMR’s own tool. This guide covers that lookup, the plans UMR routes elsewhere, its ABA process and the federal deadlines a UMR plan has to meet.
At a glance
- UMR administers more than 3,800 employer benefit plans covering 6 million members.
- Each employer’s plan sets its own prior authorization requirements.
- UMR’s online tool checks a patient’s requirements and submits the request.
- GEHA, Sierra Health-Care Options and West Virginia PEIA plans use their own portals.
- UMR recommends an ABA pre-determination even when a plan doesn’t require prior authorization.
“We have had an amazing experience with Silna to streamline prior authorizations!”Selene C., Director of OperationsSilna checks each UMR plan’s rules and submits the request for you.Get started
How to check UMR requirements
UMR’s Prior Authorization Requirement Search and Submission Tool covers most UMR-administered group health plans through the secure provider portal on umr.com. Requirements are plan-specific, so staff run the member search for each patient:
- Sign in to the provider portal with a One Healthcare ID.
- Find the patient by member ID (or SSN) and date of birth.
- Enter the service and date to see that plan’s requirement.
- If action is needed, submit the request in the same tool with the treatment type, the length of the request and the clinical documentation it asks for.
For most services, that request inside the tool is the UMR prior authorization form. The tool answers with one of four results, listed in UMR’s tool guide:
| Tool result | What staff do next |
|---|---|
| Prior authorization is required | Submit the request in the tool before the visit |
| Medical necessity review needed or pre-determination recommended | Submit a pre-determination before the visit |
| No coverage for this service | Tell the patient before scheduling |
| No procedure code requirements found | Keep the search result with the patient’s record |
UMR plans that send requests elsewhere
Three groups of plans don’t use UMR’s tool. UMR’s provider page sends each to its own portal:
| Plan | Where the request goes |
|---|---|
| GEHA medical plans | GEHA’s own provider portal |
| Sierra Health-Care Options plans | That plan’s own provider portal |
| West Virginia PEIA | PEIA’s own prior authorization portal |
Check which plan the patient carries before opening UMR’s tool.
ABA therapy requests with UMR
Not every UMR plan requires prior authorization for ABA therapy. UMR’s ABA request form still recommends a pre-determination medical necessity review, even when prior authorization isn’t needed.
To start one, call 1-800-808-4424 and choose the Behavioral Health option, then fax clinicals to the outpatient behavioral fax line at 1-844-881-7053. The request needs proof of an autism diagnosis, and an IEP or school evaluation isn’t acceptable as the only proof. UMR sends pre-determination results by letter.
Stop calling UMR’s behavioral health line for each ABA request
How long a UMR plan has to decide
UMR runs self-funded employer plans, and the federal claims rule for ERISA group health plans (29 CFR 2560.503-1) sets how long a plan can take:
- 72 hrs
- decision limit for an urgent request
- 15 days
- decision limit for a pre-service request
A plan can extend a pre-service decision once, by up to 15 days, for matters beyond its control. When the extension is for missing information, the provider gets at least 45 days to send it.
Self-insured non-federal governmental plans follow the same claims and appeals rules under 45 CFR 147.136, which generally doesn’t apply to grandfathered plans.
Appealing a UMR denial
An ERISA group health plan must allow at least 180 days to appeal a denial, and it decides a pre-service appeal within 30 days when the plan has one level of appeal. Silna’s guide covers how to appeal a prior authorization denial step by step.
How Silna handles UMR requests
Silna runs the plan-specific lookup for each UMR patient, submits the request and follows up until a decision comes back. Before a request goes out, Silna checks each document against payor- and specialty-specific requirements, such as signatures, credentials and dates.
G2 reviewers rate Silna 4.8 out of 5 across 66 verified reviews. For UnitedHealthcare’s own plans, see Silna’s guide to UnitedHealthcare prior authorization.
“Our collaboration with Silna has allowed our front desk team to focus on the needs of our families.”Holly L., Operations ManagerSilna follows each UMR request until the decision comes back.Get started
Key terms
- Third-party administrator (TPA)
- A company an employer hires to run its health plan’s claims and benefits without being the insurer.
- Self-funded plan
- A health plan where the employer pays claims itself and a TPA such as UMR administers it.
- Pre-determination
- A medical necessity review requested before a service, even when the plan doesn’t require prior authorization.
- One Healthcare ID
- The sign-in providers use for UMR’s secure provider portal and its prior authorization tool.
Frequently Asked Questions
Does UMR require prior authorization for ABA therapy?
Not every UMR plan does. UMR’s ABA form recommends a pre-determination medical necessity review either way, requested through its Behavioral Health line.
Where is the UMR prior authorization form?
For most services, the request is filled in inside UMR’s Prior Authorization Requirement Search and Submission Tool on umr.com. ABA requests use UMR’s ABA request form, with clinicals faxed to 1-844-881-7053.
Is UMR the same as UnitedHealthcare?
UMR is UnitedHealthcare’s third-party administrator. It runs self-funded employer plans, and each employer’s plan sets what needs approval.
How long does a UMR plan have to decide?
Federal rules for ERISA plans allow 72 hours for an urgent request and 15 days for a pre-service request, with one extension of up to 15 days.
This article is general educational information and does not give medical, legal or insurance advice. Each employer’s plan sets its own rules, so check the patient’s plan in UMR’s tool before you rely on it.
About the author
Jeffrey Morelli
Jeffrey Morelli is the Co-Founder and CEO of Silna Health, the first Care Readiness Platform built to remove the administrative barriers that delay care. Silna automates benefit checks, eligibility, and prior authorizations across 1,000+ payors, and is backed by $27M from Accel and Bain Capital Ventures. Before Silna, Jeff spent a decade in San Francisco building and scaling products for highly regulated industries, including leading go-to-market at Truework (Series C, acquired by Checkr).
Last updated: November 2, 2026.