Capitation and/or Delegation Supplement - 2020 UnitedHealthcare Administrative Guide
Capitation and/or Delegation Supplement
This supplement is for participating physicians, care providers, facilities and ancillary providers, and delegated accountable care organizations (ACOs) capitated for certain UnitedHealthcare products. It applies to all benefit plans for members who:
- Have been assigned to or have chosen a care provider who receives a capitation payment from us for that member, and
- Are covered under an applicable benefit plan under UnitedHealthcare.
This supplement controls if it conflicts with the main guide. For protocols, policies and procedures not referenced in this supplement, please refer to the main guide.
Topics in this Section
- What is Capitation?
- What is Delegated Accountable Care Organizations (ACO)
- How to Contact Us
- Verifying Eligibility and Effective Dates
- Commercial Eligibility, Enrollment, Transfers, and Disenrollment
- Medicare Advantage (MA) Enrollment, Eligibility and Transfers, and Disenrollment
- Authorization Guarantee
- Care Provider Responsibilities
- Delegated Credentialing Program
- Service Standards
- Virtual Visits
- Referrals & Referral Contracting
- Medical Management
- Pharmacy
- Facilities
- Claims Processes
- Claims Disputes and Appeals
- Contractual and Financial Responsibilities
- Capitation Reports and Payments
- CMS Premiums and Adjustments
- Delegate Performance Management Program
- Appeals and Grievances