Health Care Practitioners
Prior Authorization

Prior Authorization is the process of getting prior written approval from Unity for specific covered services, treatment, durable medical equipment (DME) and supplies before they are used.

Prior Authorization determines and authorizes payment –

  • For the specific type and extent of care, DME, or supply that is medically necessary
  • For a specific number of visits or the period of time during which the care will be provided
  • To a specific provider rendering the service

Unity follows a set of Prior Authorization lists that differ depending on health plan type. Failure to obtain Unity’s Prior Authorization may result in non-coverage for the service or supply.


Unity's prior authorization lists –


Important Information Regarding Prior Authorizations for State and Local Government Members

Unity Health Insurance has an additional requirement for prior authorization for certain specialty services and to expand a care coordination program for Unity members who are State and Local Government annuitants, employees and their dependents insured through Employee Trust Fund (ETF). The management of these programs has been delegated to the University of Wisconsin Medical Foundation (UWMF) Medical Management (MM) department. Learn More.

Submitting a Prior Authorization Request for services, treatments, DME and supplies –


Medication Prior Authorization



If you have questions about Unity’s prior authorization criteria or a specific determination, contact Unity’s Pharmacy Program at 888.450.4884.

For requests other than medication, contact Medical Management at 888.829.5687 or 608.821.4200. 

For additional information about other services that require prior authorization, please contact UW Health Pharmacy Benefit Management Program at 800.362.3310 Monday – Friday from 7 a.m. to 7 p.m.