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Claims and Payments
Forms, Billing and Reference Guides
Ohio Care Provider Manual
Ohio Care Provider Manual
Care Provider Manual: Chapter 1
Care Provider Manual: Chapter 2
Care Provider Manual: Chapter 3
Care Provider Manual: Chapter 4
Care Provider Manual: Chapter 4
Long-Term Services and Supports (MyCare)
Care Provider Manual: Chapter 5
Care Provider Manual: Chapter 6
Care Provider Manual: Chapter 7
Care Provider Manual: Chapter 8
Care Provider Manual: Chapter 9
Care Provider Manual: Chapter 10
Care Provider Manual: Chapter 11
Care Provider Manual: Chapter 12
Care Provider Manual: Chapter 13
Care Provider Manual: Chapter 14
Payment Policy Notifications
Pharmacy Resources and Physician Administered Drugs
Policies and Clinical Guidelines
Policies and Clinical Guidelines
Community Plan Reimbursement Policies of Ohio
Prior Authorization and Notification
Training and Education
UnitedHealthcare Connected
UnitedHealthcare Dual Complete® Special Needs Plans
Oklahoma Health Plans
Oklahoma Health Plans
Oklahoma Commercial Health Plans
OK Medicare Advantage Health Plans
OK Medicare Advantage Health Plans
Oklahoma AARP® Medicare Advantage Plans
OK Dual Complete® SNP
Oklahoma Group Medicare Advantage Plans
Oklahoma UnitedHealthcare® MedicareDirect (PFFS)
UnitedHealthcare Community Plan of Oklahoma Homepage
UnitedHealthcare Community Plan of Oklahoma Homepage
Bulletins and Newsletters
Care Provider Manuals
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Prior Authorization and Notification
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UnitedHealthcare Dual Complete® Special Needs Plans
Oregon Health Plans
Oregon Health Plans
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OR Medicare Advantage Health Plans
OR Medicare Advantage Health Plans
Oregon AARP® Medicare Advantage Plans
Oregon Assisted Living Plan
Oregon Group Medicare Advantage Plans
Oregon Nursing Home Plan
Pennsylvania Health Plans
Pennsylvania Health Plans
Pennsylvania Commercial Health Plans
PA Medicare Advantage Health Plans
PA Medicare Advantage Health Plans
Pennsylvania AARP® Medicare Advantage Plans
Pennsylvania Dual Complete® SNP
Pennsylvania Erickson Advantage® SNP Plans
Pennsylvania Erickson Advantage® Freedom/Signature Plans
Pennsylvania Group Medicare Advantage Plans
Pennsylvania Nursing Home Plan
UnitedHealthcare Community Plan of Pennsylvania Homepage
UnitedHealthcare Community Plan of Pennsylvania Homepage
Bulletins and Newsletters
Care Provider Manuals
Claims and Payments
Payment Policy Notifications
Pharmacy Resources and Physician Administered Drugs
Policies and Clinical Guidelines
Policies and Clinical Guidelines
Community Plan Reimbursement Policies of Pennsylvania
Prior Authorization and Notification
Quality Rewards Program
Training and Education
UnitedHealthcare Dual Complete® Special Needs Plans
Rhode Island Health Plans
Rhode Island Health Plans
Rhode Island Commercial Health Plans
RI Medicare Advantage Health Plans
RI Medicare Advantage Health Plans
Rhode Island AARP® Medicare Advantage Plans
Rhode Island Assisted Living Plan
Rhode Island Dual Complete® SNP
Rhode Island Group Medicare Advantage Plans
Rhode Island Nursing Home Plan
UnitedHealthcare Community Plan of Rhode Island Homepage
UnitedHealthcare Community Plan of Rhode Island Homepage
Bulletins and Newsletters
Care Provider Manuals
Claims and Payments
Payment Policy Notifications
Pharmacy Resources and Physician Administered Drugs
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Policies and Clinical Guidelines
Community Plan Reimbursement Policies of Rhode Island
Prior Authorization and Notification
Provider Forms and References
Training and Education
UnitedHealthcare Dual Complete® Special Needs Plans
SC Health Plans
SC Health Plans
SC Commercial Health Plans
SC Medicare Advantage Health Plans
SC Medicare Advantage Health Plans
SC AARP® Medicare Advantage Plans
South Carolina Dual Complete® SNP
SC Group Medicare Advantage Plans
South Carolina UnitedHealthcare Medicare Advantage Plans
SC UnitedHealthcare Medicare Gold/Silver
SD Health Plans
SD Health Plans
SD Commercial Health Plans
SD Medicare Advantage Health Plans
SD Medicare Advantage Health Plans
South Dakota Group Medicare Advantage Plans
South Dakota AARP® Medicare Advantage Plans
TN Health Plans
TN Health Plans
TN Commercial Health Plans
TN Medicare Advantage Health Plans
TN Medicare Advantage Health Plans
TN AARP® Medicare Advantage Plans
TN Dual Complete® SNP
TN Group Medicare Advantage Plans
TN Nursing Home Plan
UnitedHealthcare Community Plan of Tennessee Homepage
UnitedHealthcare Community Plan of Tennessee Homepage
Behavioral Health
Bulletins and Newsletters
Care Provider Manuals
Claims and Payments
Payment Policy Notifications
Pharmacy Resources and Physician Administered Drugs
Policies and Clinical Guidelines
Policies and Clinical Guidelines
Community Plan Reimbursement Policies of Tennessee
Prior Authorization and Notification
Provider Forms, Resources and References
Tennessee Episodes of Care / Patient Centered Medical Home / TN Health Link / Medication Therapy Management
Training and Education
UnitedHealthcare Dual Complete® Special Needs Plans
TX Health Plans
TX Health Plans
TX Commercial Health Plans
TX Medicare Advantage Health Plans
TX Medicare Advantage Health Plans
TX AARP® Medicare Advantage Plans
TX UnitedHealthcare® Chronic Complete Special Needs Plan
TX Dual Complete® SNP
TX Erickson Advantage® Freedom/Signature Plans
TX Erickson Advantage® SNP Plans
TX Group Medicare Advantage Plans
Texas UnitedHealthcare Medicare Advantage Plans
TX UnitedHealthcare® MedicareDirect (PFFS)
TX Medicare Gold/Silver
TX Nursing Home Plan
UnitedHealthcare Community Plan of Texas Homepage
UnitedHealthcare Community Plan of Texas Homepage
Bulletins and Newsletters
Care Provider Manuals
Claims and Payments
Contact Us
Electronic Visit Verification
Messages from the Texas Credentialing Alliance
Messages from the Texas Health and Human Services Commission
Payment Policy Notifications
Pharmacy Resources and Physician Administered Drugs
Policies and Clinical Guidelines
Policies and Clinical Guidelines
Community Plan Reimbursement Policies of Texas
Prior Authorization and Notification
Prior Authorization and Notification
Prior Authorization Requirements
Prior Authorization Timelines
Prior Authorization Forms
Specialty Programs Prior Authorizations
Reference Guides and Value-Added Services
Training and Education
UnitedHealthcare Dual Complete® Special Needs Plans
UT Health Plans
UT Health Plans
UT Commercial Health Plans
UT Medicare Advantage Health Plans
UT Medicare Advantage Health Plans
UT AARP® Medicare Advantage Plans
UT Group Medicare Advantage Plans
Utah UnitedHealthcare Medicare Advantage Plans
Utah UnitedHealthcare Medicare Advantage Assist plans
UT Nursing Home Plan
VT Health Plans
VT Health Plans
VT Commercial Health Plans
VT Medicare Advantage Health Plans
VT Medicare Advantage Health Plans
VT AARP® Medicare Advantage Plans
VT Group Medicare Advantage Plans
VT UnitedHealthcare® MedicareDirect (PFFS)
Vermont UnitedHealthcare Medicare Advantage Plans
VA Health Plans
VA Health Plans
Virginia Commercial Health Plans
VA Medicare Advantage Health Plans
VA Medicare Advantage Health Plans
Virginia AARP® Medicare Advantage Plans
VA Dual Complete® SNP
Virginia Erickson Advantage® Freedom/Signature Plans
Virginia Erickson Advantage® SNP Plans
Virginia Group Medicare Advantage Plans
Virginia UnitedHealthcare® MedicareDirect (PFFS)
Virginia Nursing Home Plan
Virginia Piedmont Plans
UnitedHealthcare Community Plan of Virginia Homepage
UnitedHealthcare Community Plan of Virginia Homepage
Bulletins and Newsletters
Care Provider Manuals
Claims and Payments
Payment Policy Notifications
Pharmacy Resources and Physician Administered Drugs
Policies and Clinical Guidelines
Policies and Clinical Guidelines
Community Plan Reimbursement Policies of Virginia
Prior Authorization and Notification
Provider Forms and References
Training and Education
UnitedHealthcare Dual Complete® Special Needs Plans
WA Health Plans
WA Health Plans
Washington Commercial Health Plans
WA Medicare Advantage Health Plans
WA Medicare Advantage Health Plans
Washington AARP® Medicare Advantage Plans
Washington Assisted Living Plan
Washington Dual Complete® SNP
Washington Group Medicare Advantage Plans
Washington Nursing Home Plan
UnitedHealthcare Community Plan of Washington Homepage
UnitedHealthcare Community Plan of Washington Homepage
Behavioral Health
Bulletins and Newsletters
Care Provider Manuals
Claims and Payments
Payment Policy Notifications
Pharmacy Resources and Physician Administered Drugs
Policies and Clinical Guidelines
Policies and Clinical Guidelines
Community Plan Reimbursement Policies of Washington
Prior Authorization and Notification
Training and Education
UnitedHealthcare Dual Complete® Special Needs Plans
WV Health Plans
WV Health Plans
West Virginia Commercial Health Plans
WV Medicare Advantage Health Plans
WV Medicare Advantage Health Plans
West Virginia AARP® Medicare Advantage Plans
WV Dual Complete® SNP
West Virginia Group Medicare Advantage Plans
UnitedHealthcare Community Plan of West Virginia Homepage
UnitedHealthcare Community Plan of West Virginia Homepage
Care Provider Manuals
Claims and Payments
Policies and Clinical Guidelines
Prior Authorization and Notification
UnitedHealthcare Dual Complete® Special Needs Plans
WI Health Plans
WI Health Plans
Wisconsin Commercial Health Plans
WI Medicare Advantage Health Plans
WI Medicare Advantage Health Plans
Wisconsin AARP® Medicare Advantage Plans
Wisconsin Assisted Living Plan
Wisconsin Dual Complete® SNP
Wisconsin UnitedHealthcare Medicare Advantage Plans
Wisconsin Group Medicare Advantage Plans
Wisconsin Nursing Home Plan
Wisconsin UnitedHealthcare Medicare Advantage Assist plans
UnitedHealthcare Community Plan of Wisconsin Homepage
UnitedHealthcare Community Plan of Wisconsin Homepage
Behavioral Health
Bulletins and Newsletters
Care Provider Manuals
Claims and Payments
Payment Policy Notifications
Pharmacy Resources and Physician Administered Drugs
Policies and Clinical Guidelines
Policies and Clinical Guidelines
Community Plan Reimbursement Policies of Wisconsin
Prior Authorization and Notification
Provider Forms and References
Training and Education
UnitedHealthcare Dual Complete® Special Needs Plans
WY Health Plans
WY Health Plans
WY Commercial Health Plans
WY Medicare Advantage Health Plans
WY Medicare Advantage Health Plans
WY Group Medicare Advantage Plans
Wyoming UnitedHealthcare® MedicareDirect (PFFS)
USVI Health Plans
USVI Health Plans
U.S. Virgin Islands Commercial Health Plans
Policies and Protocols
Policies and Protocols
Protocols
Clinical Guidelines
Commercial Policies
Commercial Policies
Clinical Guidelines
Dental Policies
UnitedHealthcare Commercial Medical & Drug Policies and Coverage Determination Guidelines
UnitedHealthcare Commercial Reimbursement Policies
UnitedHealthcare Commercial Reimbursement Policies
Physical Medicine & Rehabilitation: Speech Therapy Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans
Procedure to Modifier Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans
Outpatient Hospital CCI Editing Policy, Facility - Reimbursement Policy - UnitedHealthcare Commercial Plans
Physical Medicine & Rehabilitation: PT, OT and Evaluation and Management Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans
Preventive Medicine and Screening Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans
Observation and Discharge Policy, Professional - UnitedHealthcare Commercial Plans
Outpatient Hospital Maximum Frequency Per Day Policy, Facility - Reimbursement Policy - UnitedHealthcare Commercial Plans
Durable Medical Equipment, Orthotics and Prosthetics Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans
Split Surgical Package Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans
Professional/Technical Component Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans
After Hours and Weekend Care Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans
Prolonged Services Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans
Procedure and Place of Service Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans
Time Span Codes Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans
Inappropriate Primary Diagnosis Codes Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans
Obstetrical Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans
Global Days Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans
Microsurgery Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans
Drug Testing Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans
Emergency Department (ED) Facility Evaluation and Management (E&M) Coding Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans
Multiple Procedure Payment Reduction (MPPR) for Medical and Surgical Services Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans
Wrong Surgical or Other Invasive Procedures Policy, Professional and Facility - Reimbursement Policy - UnitedHealthcare Commercial Plans
Once in a Lifetime Procedures Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans
Replacement Codes Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans
Services and Modifiers Not Reimbursable to Healthcare Professionals Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans
Same Day / Same Service Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans
Maximum Frequency Per Day Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans
Increased Procedural Services Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans
Consultation Services Policy
Mohs Micrographic Surgery Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans
Nonphysician Health Care Professionals Billing Evaluation and Management Codes Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans
One or More Sessions Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans
New Patient Visit Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans
Co-Surgeon / Team Surgeon Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans
Non-Patient Facility Laboratory Services Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans
Advanced Practice Health Care Provider Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans
Pediatric and Neonatal Critical and Intensive Care Services Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans
Contrast and Radiopharmaceutical Materials Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans
Care Plan Oversight Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans
Assistant-at-Surgery Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans
Add-On Codes Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans
Intraoperative Neuromonitoring Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans
Modifier SU Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans
Urgent Care Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans
Reduced Services Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans
Ambulance Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans
Non-Physician Health Care Codes Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans
Intensity Modulated Radiation Therapy Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans
Anesthesia Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans
Supply Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans
Multiple Procedure Payment Reduction (MPPR) for Diagnostic Cardiovascular and Ophthalmology Procedures Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans
Rebundling Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans
Modifier Reference Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans
Outpatient Hospital Add-On Codes Policy, Facility - Reimbursement Policy - UnitedHealthcare Commercial Plans
Standby Services Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans
Discontinued Procedure - Reimbursement Policy - UnitedHealthcare Commercial Plans
National Drug Code (NDC) Requirement Professional & Facility Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans
From – To Date Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plan
T Status Codes Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans
Acupuncture Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans
Robotic Assisted Surgery Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans
Evaluation and Management (E/M) Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans
Molecular Pathology Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans
Bilateral Procedures Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans
Discarded Drugs and Biologicals Policy, Professional and Facility Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans
CCI Editing Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans
Physical Medicine & Rehabilitation: Multiple Therapy Procedure Reduction Policy, Professional
Molecular Pathology Policy, Frequently Asked Questions - Reimbursement Policy - UnitedHealthcare Commercial Plans
Injection and Infusion Services Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans
Telehealth and Telemedicine Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans
Laboratory Services Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans
B Bundle Codes Policy Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans
Physical Medicine & Rehabilitation: Maximum Combined Frequency Per Day Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans
Multiple Procedure Payment Reduction (MPPR) for Diagnostic Imaging Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans
Clinical Laboratory Improvement Amendments (CLIA) ID Requirement Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans
Oxford Policies
UnitedHealthcare West Benefit Interpretation Policies
UnitedHealthcare West Medical Management Guidelines
Dental Policies
Exchange Plan Policies
Exchange Plan Policies
UnitedHealthcare Value & Balance Exchange Medical & Drug Policies and Coverage Determination Guidelines
Medicare Advantage Policies
Medicare Advantage Policies
Clinical Guidelines
Medicare Advantage Coverage Summaries
Dental Policies
Medicare Advantage Policy Guidelines
Medicare Advantage Reimbursement Policies
Medicare Advantage Terms and Conditions
Community Plan Policies
Community Plan Policies
Clinical Guidelines
Dental Policies
Community Plan Medical & Drug Policies
Community Plan Reimbursement Policies
Community Plan Drug Lists for Limited Supplier Protocol
Laboratory Test Registry Protocol
Demographics and Profiles
Demographics and Profiles
Link Self-Service Tools
My Practice Profile
Area of Expertise
Attestation
Get Credentialed
Administrative Guides and Manuals
Administrative Guides and Manuals
Community Plan Care Provider Manuals for Medicaid Plans By State
Administrative Guide for Commercial, Medicare Advantage and DSNP
Administrative Guide for Commercial, Medicare Advantage and DSNP
Welcome to UnitedHealthcare 2020 UnitedHealthcare Administrative Guide
Introduction
Introduction
Manuals and Benefit Plans Referenced in the Guide
Benefit Plans Subject to this Guide
Benefit Plans Not Subject to this Guide
Online Resources and How to Contact Us
Provider Responsibilities and Standards
Provider Responsibilities and Standards
Verifying Eligibility, Benefits and Your Network Participation
Healthcare Identification (ID) Card
Access Standards
Network Participating Care Provider Responsibilities
Civil Rights
Cooperation with Quality Improvement and Patient Safety Activities
Demographic Changes
Notification of Practice or Demographic Changes (Applies to Commercial Benefit Plans in California)
Administrative Terminations for Inactivity
Member Dismissals Initiated by a PCP
Medicare Opt-Out
Additional MA Requirements
Filing a Lawsuit by a Member
Commercial Products
Commercial Products
Commercial Product Overview Table
Benefit Plan Types
PCP Selection Selection
Consumer-Driven Health Benefit Plans
Medicare Products
Medicare Products
Medicare Product Overview Tables
PCP Selection
Coverage Summaries and Policy Guidelines for MA Members
Dual Special Needs Plans Managed by Optum
Medicare Supplement Benefit Plans
Free Medicare Education for Your Staff and Patients
Referrals
Referrals
Commercial Products Referrals
Non-Participating Care Provider Referrals (All Commercial Plans)
Medicare Advantage Referral Required Plans
Medical Management
Medical Management
Benefit Plans Not Subject to this Protocol
Advance Notification/Prior Authorization Requirements
Advance Notification/Prior Authorization List
Facilities: Standard Notification Requirements
How to Submit Advance or Admission Notifications/ Prior Authorizations
Updating Advance Notification or Prior Authorization Requests
Coverage and Utilization Management Decisions
Pre-Service Appeals
Clinical Trials, Experimental or Investigational Services
Medical Management Denials/Adverse Determinations
MA Part C Reopenings
Outpatient Cardiology Notification/Prior Authorization Protocol
Outpatient Radiology Notification/Prior Authorization Protocol
Trauma Services
Medication-Assisted Treatment (MAT)
Specialty Pharmacy and Medicare Advantage Pharmacy
Specialty Pharmacy and Medicare Advantage Pharmacy
Commercial Pharmacy
Specialty Pharmacy Requirements for Certain Specialty Medications (Commercial Plans - Not Applicable to UnitedHealthcare West) - Chapter 7, 2020 UnitedHealthcare Administrative Guide
MA Pharmacy
Drug Utilization Review Program
Medication Therapy Management (MTM)
Transition Policy
Specific Protocols
Specific Protocols
Laboratory Services Protocol
Nursing Home and Assisted Living Plans
Non-Emergent Ambulance Ground Transportation
Our Claims Process
Our Claims Process
Electronic Payments and Statements (EPS)
Claims and Encounter Data Submissions
Risk Adjustment Data – MA and Commercial
National Provider Identification (NPI)
Medicare Advantage Claim Processing Requirements
Claim Submission Tips
Pass-through Billing/CLIA Requirements/Reimbursement Policy
Special Reporting Requirements for Certain Claim Types
Overpayments
Subrogation and Coordination of Benefits
Claim Correction and Resubmission
Claim Reconsideration, Appeals Process and Resolving Disputes
Resolving Concerns or Complaints
Member Appeals, Grievances or Complaints
Medical Claim Review
Compensation
Compensation
Reimbursement Policies
Charging Members
Member Financial Responsibility
Preventive Care
Provider Audits - Extrapolation
Hospital Audit Services
Audit Failure Denials
Notice of Medicare Non-Coverage (NOMNC)
Medical Records Standards and Requirements
Health and Disease Management
Health and Disease Management
Health Management Programs
Case Management
Commercial Health Services, Wellness and Behavioral Health Programs
Commercial Consumer Transparency Tools
Medicare Advantage (MA)
Commercial and Medicare Advantage Behavioral Health Information
Quality Management (QM) Program
Quality Management (QM) Program
UnitedHealth Premium Designation Program (Commercial Plans)
Star Ratings for MA and Prescription Drug Plans
Member Satisfaction
Imaging Accreditation Protocol
Credentialing and Re-Credentialing
Credentialing and Re-Credentialing
Credentialing/Profile Reporting Requirements
Care Provider Rights Related to the Credentialing Process
Credentialing Committee Decision Making Process (Non-Delegated)
Monitoring of All Network Care Providers
Member Rights and Responsibilities
Fraud, Waste and Abuse (FWA)
Fraud, Waste and Abuse (FWA)
Medicare Compliance Expectations and Training
Exclusion Checks
Preclusion List Policy
Examples of Potentially Fraudulent, Wasteful, or Abusive Billing (not an inclusive list)
Prevention and Detection
Corrective Action Plans
Beneficiary Inducement Law
Reporting Potential Fraud, Waste or Abuse to UnitedHealthcare
Provider Communication
Provider Communication
Network Bulletin and Provider News
Medical Policy Update Bulletin
Other Communications
All Savers Supplement
All Savers Supplement
How to Contact All Savers, All Savers Supplement
Capitation and/or Delegation Supplement
Capitation and/or Delegation Supplement
What is Capitation?
What Is a Delegated ACO?
How to Contact Us, Capitation and/or Delegation
Verifying Eligibility and Effective Dates, Capitation and/or Delegation
Commercial Eligibility, Enrollment, Transfers and Disenrollment, Capitation and/or Delegation
Medicare Advantage (MA) Enrollment, Eligibility and Transfers, and Disenrollment, Capitation and/or Delegation
Authorization Guarantee, Capitation and/or Delegation
Care Provider Responsibilities, Capitation and/or Delegation
Delegated Credentialing Program, Capitation and/or Delegation
Service Standards
Virtual Visits
Referrals & Referral Contracting
Medical Management, Capitation and/or Delegation
Pharmacy, Capitation and/or Delegation Supplement
Facilities, Capitation and/or Delegation Supplement
Claims Processes, Capitation and/or Delegation Supplement
Claims Disputes and Appeals, Capitation and/or Delegation Supplement
Capitation Reports and Payments, Capitation and/or Delegation Supplement
Contractual and Financial Responsibilities, Capitation and/or Delegation Supplement
CMS Premiums and Adjustments, Capitation and/or Delegation Supplement
Delegate Performance Management Program, Capitation and/or Delegation Supplement
Appeals and Grievances, Capitation and/or Delegation Supplement
Leased Networks
Medica Healthcare Supplement
Medica Healthcare Supplement
How to Contact Us, Medica
Confidentiality of Protected Health Information (PHI)
Referrals
Prior Authorizations
Appeals and Reconsideration Processes
Member Rights and Responsibilities, Medica
Documentation and Confidentiality of Medical Records
Provider Reporting Responsibilities, Medica
Mid-Atlantic Regional Supplement
Mid-Atlantic Regional Supplement
Provider Responsibilities
Referrals
Prior Authorizations
Claims Process
Capitation
Neighborhood Health Partnership Supplement
Neighborhood Health Partnership Supplement
How to Contact NHP
Discharge of a Member from Participating Provider's Care
Laboratory Services
Referrals
Utilization Management (UM)
Claims Reconsiderations and Appeals
Capitated Health Care Provider
OneNet PPO Supplement
OneNet PPO Supplement
Who to Contact
Referrals
Medical Records Standards and Requirements
Quality Management and Health Management Programs
Participant Rights and Responsibilities
Bills Process
Provider Responsibilities and Workflows
Oxford Commercial Supplement
Oxford Commercial Supplement
Oxford Commercial Product Overview
How to Contact Oxford Commercial
Care Provider Responsibilities and Standards, Oxford
Referrals, Oxford
Utilization Management, Oxford
Using Non-Participating Health Care Providers or Facilities, Oxford
Radiology, Cardiology and Radiation Therapy Procedures
Emergencies and Urgent Care
Utilization Reviews, Oxford
Claims Process, Oxford
Member Billing
Claims Recovery, Appeals, Disputes and Grievances
Quality Assurance, Oxford
Case Management and Disease Management Programs
Clinical Process Definitions
Member Rights and Responsibilities
Medical and Administrative Policy Updates, Oxford
Preferred Care Partners Supplement
Preferred Care Partners Supplement
About Preferred Care Partners
How to Contact Preferred Care Partners
Confidentiality of Protected Health Information (PHI), Preferred Care Partners
Prior Authorizations and Referrals, Preferred Care Partners
Clinical Coverage Review, Preferred Care Partners
Appeal & Reconsideration Processes, Preferred Care Partners
Member Rights and Responsibilities
Documentation and Confidentiality of Medical Records, Preferred Care Partners
Case Management and Disease Management Program Information, Preferred Care Partners
Special Needs Plans, Preferred Care Partners
Care Provider Reporting Responsibilities, Preferred Care Partners
River Valley Entities Supplement
River Valley Entities Supplement
Eligibility, River Valley
How to Contact River Valley
Reimbursement Policies, River Valley
Referrals, River Valley
Utilization Management, River Valley
Claims Process, River Valley
UnitedHealthcare West Supplement
UnitedHealthcare West Supplement
UnitedHealthcare West Information Regarding our Care Provider Website
How to Contact UnitedHealthcare West Resources
Care Provider Responsibilities, UnitedHealthcare West
Utilization and Medical Management, UnitedHealthcare West
Hospital Notifications, UnitedHealthcare West
Pharmacy Network, UnitedHealthcare West
Claims Process, UnitedHealthcare West
Care Provider Claims Appeals and Disputes, UnitedHealthcare West
California Language Assistance Program (California Commercial Plans), UnitedHealthcare West
Member Complaints & Grievances, UnitedHealthcare West
California Quality Improvement Committee, UnitedHealthcare West
UnitedHealthOne Individual Plans Supplement
UnitedHealthOne Individual Plans Supplement
How to Contact UnitedHealthOne Resources
Claims Process, UnitedHealthOne
Member Complaints & Grievances, UnitedHealthOne
Glossary
Reports and Quality Programs
Reports and Quality Programs
CAHPS / HOS
Home Health and SNF High-Performing Provider Initiative Lists
Hospital Performance
PATH
Peer Comparison Reports
Physician Performance
Quality-Based Physician Incentive Program (QPIP)
Quality-Based Shared Savings Program (QSSP)
Star Ratings Program
UnitedHealthcare Capitation, Claim, Quality, Roster and Profile Reports
UnitedHealthcare West Capitation, Settlement, Shared Risk Claims, Eligibility, and Patient Management Reports
UnitedHealth Premium® Program
New User Registration
New User Registration
Link Self-Service Tools
Testing Folder
Testing Folder
Test Left nav page
Raye Test Left Nav
Health Plans by State
Tennessee Health Plans
Tennessee Medicare Advantage Health Plans
Tennessee Group Medicare Advantage Plans
Print
Tennessee UnitedHealthcare® Group Medicare Advantage Plans
Tools and Resources - UnitedHealthcare® Group Medicare Advantage Plans
Medicare Advantage Chiropractic and Acupuncture Coverage – Quick Reference Guide
Medicare Advantage Copayment Guidelines
Medicare Advantage Durable Medical Equipment (DME) Frequently Asked Questions
Medicare Advantage Home Health Services Frequently Asked Questions
Medicare Advantage Member Rights and Responsibilities
Medicare Advantage Non-Contracted Provider Dispute and Appeal Rights
Medicare Advantage Non-Contracted Provider Claim Payment Dispute Request Form
Medicare Advantage Plans - Benefit Plan Name Overview
Medicare Advantage Preventive Screening Guidelines
Medicare Advantage Service Area Reductions for 2021 Frequently Asked Questions
Readmission Review Program Clinical Guidelines
Readmission Review Program Frequently Asked Questions
UnitedHealthcare Group Medicare Advantage (PPO) Network Care Provider Quick Reference Guide
UnitedHealthcare Group Medicare Advantage (PPO) Out-of-Network Care Provider Quick Reference Guide
UnitedHealth Passport® Service Area List for Medicare Advantage Group Retiree Plans
UnitedHealthcare Administrative Guide
