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Clinical Pharmacy Clinical Guidelines & Policies - UnitedHealthcare Community Plan of Louisiana
Reimbursement Policies for Community Plan of Louisiana
Prior Authorization and Notification
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Provider Training
UnitedHealthcare Dual Complete® Special Needs Plans
Maine Health Plans
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UnitedHealthcare Community Plan of Maine Homepage
UnitedHealthcare Community Plan of Maine Homepage
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Claims and Payments | UnitedHealthcare Community Plan of Maine
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Maryland Health Plans
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UnitedHealthcare Community Plan of Maryland Homepage
UnitedHealthcare Community Plan of Maryland Homepage
Bulletins and Newsletters
Bulletins and Newsletters
Practice Matters - Maryland
Practice Matters - Maryland
Are Your Patients Reluctant to Ask Questions?
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Fourth Quarter 2020 Preferred Drug List Update
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Radiology and Cardiology Prior Authorization Requests
Referral Process/Referrals tool
Screening for Colorectal Cancer
Shared Decision-Making Program – Say Y.E.S. to Good Health!
State Required Promotion of COVID-19 Testing
What a Case Manager Provides to Members
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Massachusetts Health Plans
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UnitedHealthcare Community Plan of Massachusetts Homepage
UnitedHealthcare Community Plan of Massachusetts Homepage
Bulletins and Newsletters
Bulletins and Newsletters
Practice Matters - Massachusetts
Practice Matters - Massachusetts
Benefit enhancements for Massachusetts dual special needs plan (DSNP)
Care Provider Manuals
Claims and Payments | UnitedHealthcare Community Plan of Massachusetts
Payment Policy Notifications
Pharmacy Resources and Physician Administered Drugs
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Policies and Clinical Guidelines
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Michigan Health Plans
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UnitedHealthcare Community Plan of Michigan Homepage
UnitedHealthcare Community Plan of Michigan Homepage
Bulletins and Newsletters
Bulletins and Newsletters
Practice Matters - Michigan
Practice Matters - Michigan
Fall 2020: Advancing Health Equity Multi-Credit Education
Fall 2020: Michigan Drug Coverage Changes
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Care Provider Manuals
Contact Us
Claims and Payments | UnitedHealthcare Community Plan of Michigan
Healthy Michigan Risk Assessment
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Minnesota Health Plans
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UnitedHealthcare Community Plan of Mississippi Homepage
Bulletins and Newsletters
Bulletins and Newsletters
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Practice Matters - Mississippi
Fall 2020: A Team Approach to Managing Members with Diabetes
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Fall 2020: UnitedHealthcare Dual Complete: Mississippi Members Matched with a Navigator
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UnitedHealthcare Community Plan of Missouri Homepage
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Bulletins and Newsletters
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Practice Matters - Missouri
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Montana Health Plans
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Nebraska Health Plans
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UnitedHealthcare Community Plan of Nebraska Homepage
UnitedHealthcare Community Plan of Nebraska Homepage
Behavioral Health
Bulletins and Newsletters
Bulletins and Newsletters
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Practice Matters - Nebraska
New Transportation Benefit Provider
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Care Provider Manuals
Claims and Payments | UnitedHealthcare Community Plan of Nebraska
Payment Policy Notifications
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Nevada Health Plans
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New Hampshire Health Plans
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UnitedHealthcare Community Plan of New Jersey Homepage
UnitedHealthcare Community Plan of New Jersey Homepage
Bulletins and Newsletters
Bulletins and Newsletters
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Practice Matters - New Jersey
Access and Availability Standards
A Member’s Right to Culturally Competent Care
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Case Managers Help Members With Complex Needs
Early Elective Delivery Reimbursement Changes
Managing Medication for People With Asthma
Measures for Respiratory Conditions
New Disease Management Program in New Jersey for End-Stage Renal Disease
Office-Based Addictions Treatment
Perinatal Risk Assessment Form Requirements
Providers Must Obtain Hospital Privileges
Referral Reminder: Out-of-Network Labs
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Managed Long-Term Care Services and Supports (MLTSS)
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New Mexico Health Plans
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UnitedHealthcare Community Plan of New York Homepage
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North Carolina Health Plans
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UnitedHealthcare Community Plan of North Carolina Homepage
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UnitedHealthcare Dual Complete® Special Needs Plans
Other Resources
North Dakota Health Plans
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Ohio Health Plans
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UnitedHealthcare Community Plan of Ohio Homepage
Bulletins and Newsletters
Bulletins and Newsletters
Practice Matters - Ohio
Practice Matters - Ohio
Benefit enhancements for Ohio dual special needs plan (DSNP)
Fall 2020: Change in Transportation Vendor Network
Fall 2020: Electronic Visit Verification - Phase 3
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Fall 2020: Ohio Suicide Prevention Initiative
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Fall 2020: Diabetic Self-Management Education
Transportation to Food Resources for UHC Community Plan of Ohio Members
Claims and Payments | UnitedHealthcare Community Plan of Ohio
Forms, Billing and Reference Guides
Ohio Care Provider Manual
Ohio Care Provider Manual
Care Provider Manual | Chapter 1: Introduction | UnitedHealthcare Community Plan of Ohio
Care Provider Manual | Chapter 2: Care Provider Standards & Policies | UnitedHealthcare Community Plan of Ohio
Care Provider Manual | Chapter 3: Office Procedures and Member Benefits | UnitedHealthcare Community Plan of Ohio
Care Provider Manual | Chapter 4: Medical Management | UnitedHealthcare Community Plan of Ohio
Care Provider Manual | Chapter 4: Medical Management | UnitedHealthcare Community Plan of Ohio
Long-Term Services and Supports (MyCare)
Care Provider Manual | Chapter 5: Early, Periodic Screening, Diagnosis and Treatment / Prevention | UnitedHealthcare Community Plan of Ohio
Care Provider Manual | Chapter 6: Value-Added Services | UnitedHealthcare Community Plan of Ohio
Care Provider Manual | Chapter 7: Mental Health and Substance Use | UnitedHealthcare Community Plan of Ohio
Care Provider Manual | Chapter 8: Member Rights and Responsibilities | UnitedHealthcare Community Plan of Ohio
Care Provider Manual | Chapter 9: Medical Records | UnitedHealthcare Community Plan of Ohio
Care Provider Manual | Chapter 10: Quality Management (QM) Program and Compliance Information | UnitedHealthcare Community Plan of Ohio
Care Provider Manual | Chapter 11: Billing and Submission | UnitedHealthcare Community Plan of Ohio
Care Provider Manual | Chapter 12: Claim Reconsiderations, Appeals and Grievances | UnitedHealthcare Community Plan of Ohio
Care Provider Manual | Chapter 13: Care Provider Communications & Outreach | UnitedHealthcare Community Plan of Ohio
Care Provider Manual | Chapter 14: Glossary | UnitedHealthcare Community Plan of Ohio
Payment Policy Notifications
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Pharmacy Resources and Physician Administered Drugs
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Prior Authorization and Notification
Training and Education
UnitedHealthcare Connected
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Ohio Department of Medicaid Telehealth Unified Policy
Oklahoma Health Plans
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UnitedHealthcare Community Plan of Oklahoma Homepage
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Policies and Clinical Guidelines
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Training and Education
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Oregon Health Plans
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Pennsylvania Health Plans
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UnitedHealthcare Community Plan of Pennsylvania Homepage
UnitedHealthcare Community Plan of Pennsylvania Homepage
Bulletins and Newsletters
Bulletins and Newsletters
Practice Matters - Pennsylvania
Practice Matters - Pennsylvania
Additional Incentive Program
Benefit enhancements for Pennsylvania dual special needs plan (DSNP)
COVID-19 Resources Reminder
Family Visiting Program
Key to Know… Changes to Well-Child Measures in 2020
Low Acuity Non-Emergent Follow Up Appointments
Special Needs Unit Reminder
UnitedHealthcare Dual Complete: Pennsylvania Members Matched with a Navigator.
Spotlight for Home Health Providers
We’re Your Partner to Connect with Members benefits and services
HEDIS® Measure: Appropriate Testing for Children with Pharyngitis
Long-Acting Reversible Contraceptives
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Early and Periodic Screening, Diagnosis and Treatment (EPSDT)
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Rhode Island Health Plans
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UnitedHealthcare Community Plan of Rhode Island Homepage
UnitedHealthcare Community Plan of Rhode Island Homepage
Bulletins and Newsletters
Bulletins and Newsletters
Practice Matters - Rhode Island
Practice Matters - Rhode Island
Increased Member Satisfaction Revealed by CAHPS Survey
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Care Provider Manuals
Claims and Payments | UnitedHealthcare Community Plan of Rhode Island
Payment Policy Notifications
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Policies and Clinical Guidelines
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Prior Authorization and Notification
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UnitedHealthcare Dual Complete® Special Needs Plans
Rhode Island Newborn Notification Form
South Carolina Health Plans
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Tennessee Health Plans
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UnitedHealthcare Community Plan of Tennessee Homepage
UnitedHealthcare Community Plan of Tennessee Homepage
Behavioral Health
Bulletins and Newsletters
Bulletins and Newsletters
Practice Matters - Tennessee
Practice Matters - Tennessee
Antipsychotic Pharmacotherapy: TennCare Preferred Drug List & Appropriate Diagnosis for Prior Authorization Bypass
Adult Checkup Reminder
CoverKids Implementation – 1/1/2021
Covid-19 Updates | TN Practice Matters
Electronic Visit Verification (EVV) Overlapping Visits
EPSDT Campaign 2020 Thank you
EPSDT Coding Guide 2021 | TN Practice Matters
EPSDT Coding Guide
Fraud, Waste, and Abuse Update – Foot Baths and Prescription Anti-Infective Agents
Flu Season Reminder
Healthcare Professional Community Engagement Partnership
Importance of EPSDT Screenings
Our Tennessee Quality Management program
Person-Centered Support Plans (PCSP) and Functional Assessments (FA) available on Provider Portal
Pneumococcal Screening Reminder
Regulatory Appendix Update
Summary of 2020 EPSDT Medical Record Review
TennCare Is Waiving Risk-Sharing Payments for 2019 Episodes of Care in Response to COVID-19
UnitedHealthcare Dual Complete: Tennessee Members Matched With a Navigator
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Care Provider Manuals
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Training and Education
UnitedHealthcare Dual Complete® Special Needs Plans
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UnitedHealthcare Community Plan of Texas Homepage
Bulletins and Newsletters
Bulletins and Newsletters
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Practice Matters - Texas
Dental Prevention - More than Mouth Care
Help When and Where It’s Needed
Making the Most of Life While Living With Complex Care Needs
Texas Community Plan Quality Newsletter
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Claims and Payments | UnitedHealthcare Community Plan of Texas
Contact Us
Electronic Visit Verification (EVV)
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Pharmacy Resources and Physician Administered Drugs
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Policies and Clinical Guidelines
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Prior Authorization and Notification
Prior Authorization and Notification
Prior Authorization Requirements - UnitedHealthcare Community Plan of Texas
Prior Authorization Timelines - UnitedHealthcare Community Plan of Texas
Prior Authorization Forms - UnitedHealthcare Community Plan of Texas
Specialty Programs Prior Authorizations - UnitedHealthcare Community Plan of Texas
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Virginia Health Plans
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UnitedHealthcare Community Plan of Virginia Homepage
UnitedHealthcare Community Plan of Virginia Homepage
Bulletins and Newsletters
Bulletins and Newsletters
Practice Matters - Virginia
Practice Matters - Virginia
Social Determinants of Health Protocol
Resources to Help You Prepare for a Challenging Influenza Season
How to Manage and Close the Measure
Community & State Plan: 2020 Transportation Benefit Information
Annual Wellness Visit Through Telehealth
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment
Medication Reconciliation Post-Discharge (MRP)
UnitedHealthcare Dual Complete: Virginia Members Matched with a Navigator
Virginia Medicaid Appointment Standards
Member Experience Survey Virginia Medicaid
Important Outreach to Your Patients Receiving MAT
Earn $50.00 for Obstetrical Risk Assessment submissions
Care Provider Manuals
Claims and Payments | UnitedHealthcare Community Plan of Virginia
Payment Policy Notifications
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Washington Health Plans
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UnitedHealthcare Community Plan of Washington Homepage
Behavioral Health
Bulletins and Newsletters
Bulletins and Newsletters
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Practice Matters - Washington
Behavioral Health Services
Benefit enhancements for Washington dual special needs plan (DSNP)
Care Coordination
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Pregnancy Intention Screening: Family Planning for Social Change
UnitedHealthcare Dual Complete: Washington Members Matched With a Navigator
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UnitedHealthcare Dual Complete® Special Needs Plans
West Virginia Health Plans
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UnitedHealthcare Community Plan of West Virginia Homepage
UnitedHealthcare Community Plan of West Virginia Homepage
Care Provider Manuals
Claims and Payments | UnitedHealthcare Community Plan of West Virginia
Policies and Clinical Guidelines
Prior Authorization and Notification
UnitedHealthcare Dual Complete® Special Needs Plans
Wisconsin Health Plans
Wisconsin Health Plans
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UnitedHealthcare Community Plan of Wisconsin Homepage
Behavioral Health
Bulletins and Newsletters
Bulletins and Newsletters
Practice Matters - Wisconsin
Practice Matters - Wisconsin
Benefit enhancements for Wisconsin dual special needs plan (DSNP)
Care Provider Manuals
Claims and Payments | UnitedHealthcare Community Plan of Wisconsin
Payment Policy Notifications
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Policies and Clinical Guidelines
Policies and Clinical Guidelines
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Prior Authorization and Notification
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UnitedHealthcare Dual Complete® Special Needs Plans
Wyoming Health Plans
Wyoming Health Plans
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US Virgin Islands Health Plans
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Commercial Master
CS Payment Policies
Updated Medicare Master National Docs
2020 DSNP County Expansion
UnitedHealthcare Community Plan (Medicaid) Pre-Service Appeals & Grievances
Find COVID-19 vaccine availability for your state or territory
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Policies and Protocols
Protocols
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UnitedHealthcare Oxford Clinical, Administrative and Reimbursement Policies
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Exchange Plans Policies
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Medical & Drug Policies and Coverage Determination Guidelines for UnitedHealthcare Value & Balance Exchange
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Medicare Advantage Policies
Medicare Advantage Policies
Clinical Guidelines
Coverage Summaries for Medicare Advantage Plans
Dental Clinical Policies and Coverage Guidelines
Policy Guidelines for Medicare Advantage Plans
Reimbursement Policies for Medicare Advantage Plans
Terms and Conditions for Certain Incentive Programs
Policy Search Index
Community Plan Policies
Community Plan Policies
Clinical Guidelines
Dental Clinical Policies and Coverage Guidelines
Medical & Drug Policies and Coverage Determination Guidelines for Community Plan
Reimbursement Policies for Community Plan
Community Plan Drug Lists for Limited Supplier Protocol
Requirements for Out-of-Network Laboratory Referral Requests
Laboratory Test Registry Protocol
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InterQual Clinical Criteria
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Demographics and Profiles
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Care Provider Administrative Guides and Manuals
Care Provider Administrative Guides and Manuals
Community Plan Care Provider Manuals for Medicaid Plans By State
2020 Administrative Guide REDIRECT
2020 Administrative Guide REDIRECT
2018-uhc-admin-guide
2019 Administrative Guide REDIRECT
2021 Administrative Guide for Commercial, Medicare Advantage and DSNP
2021 Administrative Guide for Commercial, Medicare Advantage and DSNP
Welcome to UnitedHealthcare 2021 Administrative Guide
Quick reference guide 2021 Administrative Guide
Introduction - Ch.1, 2021 Administrative Guide
Introduction - Ch.1, 2021 Administrative Guide
Manuals and benefit plans referenced in the guide - 2021 Administrative Guide
Online/interoperability resources and how to contact us
Provider responsibilities and standards - Ch.2, 2021 Administrative Guide
Provider responsibilities and standards - Ch.2, 2021 Administrative Guide
Verifying eligibility, benefits and your network participation status - 2021 Administrative Guide
Healthcare plan identification (ID) cards - 2021 Administrative Guide
Access standards - 2021 Administrative Guide
Network participating care provider responsibilities - 2021 Administrative Guide
Civil rights - 2021 Administrative Guide
Cooperation with quality improvement and patient safety activities - 2021 Administrative Guide
Demographic changes - 2021 Administrative Guide
Notification of practice or demographic changes (Applies to Commercial Benefit Plans in California) - 2021 Administrative Guide
Administrative terminations for inactivity - 2021 Administrative Guide
Member dismissals initiated by a PCP (Medicare Advantage) - 2021 Administrative Guide
Medicare opt-out - 2021 Administrative Guide
Additional Medicare Advantage requirements - 2021 Administrative Guide
Filing a lawsuit by a member - 2021 Administrative Guide
Commercial products - Ch.3, 2021 Administrative Guide
Commercial products - Ch.3, 2021 Administrative Guide
Commercial product overview table - 2021 Administrative Guide
Benefit plan types - 2021 Administrative Guide
PCP selection - 2021 Administrative Guide
Consumer-driven health benefit plans - 2021 Administrative Guide
Health Insurance Marketplace (Exchanges) - Chapter 4, 2021 Administrative Guides
Health Insurance Marketplace (Exchanges) - Chapter 4, 2021 Administrative Guides
Individual marketplace vs. small business health options program marketplace - 2021 Administrative Guide
UnitedHealthcare’s participation in Exchanges - 2021 Administrative Guide
What is the health insurance marketplace? - 2021 Administrative Guide
Plan coverage and metal levels - 2021 Administrative Guide
UnitedHealthcare benefit plans for exchanges - 2021 Administrative Guide
Understanding your network participation - 2021 Administrative Guide
Verifying eligibility and benefits - 2021 Administrative Guide
Plan requirements/features - 2021 Administrative Guide
Patient care coordination and case management - 2021 Administrative Guide
Telehealth visits - 2021 Administrative Guide
Pharmacy - 2021 Administrative Guide
Specialty services (hearing, vision, dental, transplant, behavioral health, chiropractor, skilled nursing facility) - 2021 Administrative Guide
Claims process - 2021 Administrative Guide
Policies and protocols - 2021 Administrative Guide
Quick reference guide - 2021 Administrative Guide
Medicare products - Ch.5, 2021 Administrative Guide
Medicare products - Ch.5, 2021 Administrative Guide
Medicare product overview tables - 2021 Administrative Guide
PCP selection - 2021 Administrative Guide
Coverage summaries and policy guidelines for MA members - 2021 Administrative Guide
Dual special needs plans managed by Optum - 2021 Administrative Guide
Medicare supplement benefit plans - 2021 Administrative Guide
Free Medicare education for your staff and patients - 2021 Administrative Guide
Referrals - Ch.6, 2021 Administrative Guide
Referrals - Ch.6, 2021 Administrative Guide
Commercial products referrals - 2021 Administrative Guide
Non-Participating Care Provider Referrals (All Commercial Plans) - 2021 Administrative Guide
Medicare Advantage Referral Required Plans - 2021 Administrative Guide
Individual Advantage Referral Required Plans - 2021 Administrative Guide
Medical management - Ch.7, 2021 Administrative Guide
Medical management - Ch.7, 2021 Administrative Guide
Benefit plans not subject to this protocol - 2021 Administrative Guide
Advance notification/prior authorization requirements - 2021 Administrative Guide
Advance notification/prior authorization list - 2021 Administrative Guide
Facilities: Standard notification requirements - 2021 Administrative Guide
How to submit advance or admission notifications/ prior authorizations - 2021 Administrative Guide
Updating advance notification or prior authorization requests - 2021 Administrative Guide
Coverage and utilization management decisions - 2021 Administrative Guide
Pre-service appeals - 2021 Administrative Guide
Clinical trials, experimental or investigational services - 2021 Administrative Guide
Medical management denials/adverse determinations - 2021 Administrative Guide
MA Part C reopenings - 2021 Administrative Guide
Outpatient cardiology notification/prior authorization protocol - 2021 Administrative Guide
Outpatient radiology notification/prior authorization protocol - 2021 Administrative Guide
Medication-assisted treatment (MAT) - 2021 Administrative Guide
Trauma services - 2021 Administrative Guide
Air Ambulance Licensure - 2021 Administrative Guide
Specialty pharmacy and Medicare Advantage pharmacy - Ch.8, 2021 Administrative Guide
Specialty pharmacy and Medicare Advantage pharmacy - Ch.8, 2021 Administrative Guide
Commercial pharmacy - Ch.8, 2021 Administrative Guide
Specialty pharmacy requirements for certain medical benefit specialty medications
MA pharmacy - Ch.8, 2021 Administrative Guide
Drug utilization review program - Ch.8, 2021 Administrative Guide
Drug management program (DMP) - Ch.8, 2021 Administrative Guide
Medication Therapy Management (MTM) - Ch.8, 2021 Administrative Guide
Transition policy - Ch.8, 2021 Administrative Guide
Specific protocols - Ch.9, 2021 Administrative Guide
Specific protocols - Ch.9, 2021 Administrative Guide
Non-Emergent ambulance ground transportation - Ch.9, 2021 Administrative Guide
Interoperability protocol - Ch.9, 2021 Administrative Guide
Laboratory services protocol - Ch.9, 2021 Administrative Guide
Nursing home and assisted living plans - Ch.9, 2021 Administrative Guide
Social determinants of health protocol - Ch.9, 2021 Administrative Guide
Telehealth services protocol - Ch.9, 2021 Administrative Guide
Our claims process - Ch.10, 2021 Administrative Guide
Our claims process - Ch.10, 2021 Administrative Guide
Optum Pay - Ch.10, 2021 Administrative Guide
Virtual card payments - Ch.10, 2021 Administrative Guide
Enroll and learn more about Optum Pay - Ch.10, 2021 Administrative Guide
Claims and encounter data submissions - Ch.10, 2021 Administrative Guide
Risk adjustment data – MA and commercial - Ch.10, 2021 Administrative Guide
National Provider Identification (NPI) - Ch.10, 2021 Administrative Guide
Medicare Advantage claim processing requirements - Ch.10, 2021 Administrative Guide
Claim submission tips - Ch.10, 2021 Administrative Guide
Pass-through billing - Ch.10, 2021 Administrative Guide
Special reporting requirements for certain claim types - Ch.10, 2021 Administrative Guide
Overpayments - Ch.10, 2021 Administrative Guide
Subrogation and coordination of benefits - Ch.10, 2021 Administrative Guide
Claim correction and resubmission - Ch.10, 2021 Administrative Guide
Claim reconsideration, appeals process - Ch.10, 2021 Administrative Guide
Resolving concerns or complaints - Ch.10, 2021 Administrative Guide
Member appeals, grievances or complaints - Ch.10, 2021 Administrative Guide
Medical claim review - Ch.10, 2021 Administrative Guide
Compensation - Ch.11, 2021 Administrative Guide
Compensation - Ch.11, 2021 Administrative Guide
Reimbursement policies - Ch.11, 2021 Administrative Guide
Charging members - Ch.11, 2021 Administrative Guide
Member financial responsibility - Ch.11, 2021 Administrative Guide
Preventive care - Ch.11, 2021 Administrative Guide
Extrapolation - Ch.11, 2021 Administrative Guide
Audit services - Ch.11, 2021 Administrative Guide
Audit failure denials - Ch.11, 2021 Administrative Guide
Notice of Medicare Non-Coverage (NOMNC) - Ch.11, 2021 Administrative Guide
Medical records standards and requirements - Ch.12, 2021 Administrative Guide
Health and disease management - Ch.13, 2021 Administrative Guide
Health and disease management - Ch.13, 2021 Administrative Guide
Health management programs - Ch.13, 2021 Administrative Guide
Case management - Ch.13, 2021 Administrative Guide
Commercial health services, wellness and behavioral health programs - Ch.13, 2021 Administrative Guide
Commercial consumer transparency tools- Ch.13, 2021 Administrative Guide
Medicare Advantage (MA) - Ch.13, 2021 Administrative Guide
Commercial and Medicare Advantage behavioral health information - Ch.13, 2021 Administrative Guide
Quality Management (QM) program - Ch.14, 2021 Administrative Guide
Quality Management (QM) program - Ch.14, 2021 Administrative Guide
UnitedHealth Premium® program (commercial plans) - Ch.14, 2021 Administrative Guide
Star ratings for MA and prescription drug plans - Ch.14, 2021 Administrative Guide
Member satisfaction - Ch.14, 2021 Administrative Guide
Imaging accreditation protocol - Ch.14, 2021 Administrative Guide
Credentialing and recredentialing - Ch.15, 2021 Administrative Guide
Credentialing and recredentialing - Ch.15, 2021 Administrative Guide
Credentialing/profile reporting requirements - Ch.15, 2021 Administrative Guide
Care provider rights related to the credentialing process - Ch.15, 2021 Administrative Guide
Credentialing committee decision-making process (non-delegated) - Ch.15, 2021 Administrative Guide
Monitoring of network care providers and health care professionals - Ch.15, 2021 Administrative Guide
Member rights and responsibilities - Ch.16, 2021 Administrative Guide
Fraud, Waste and Abuse (FWA) - Ch.17, 2021 Administrative Guide
Fraud, Waste and Abuse (FWA) - Ch.17, 2021 Administrative Guide
Medicare compliance expectations and training - Ch.17, 2021 Administrative Guide
Exclusion checks - Ch.17, 2021 Administrative Guide
Preclusion list policy - Ch.17, 2021 Administrative Guide
Examples of potentially fraudulent, wasteful, or abusive billing (not an inclusive list) - Ch.17, 2021 Administrative Guide
Prevention and detection - Ch.17, 2021 Administrative Guide
Corrective action plans - Ch.17, 2021 Administrative Guide
Beneficiary inducement law - Ch.17, 2021 Administrative Guide
Reporting potential fraud, waste or abuse to UnitedHealthcare- Ch.17, 2021 Administrative Guide
Provider communication - Ch.18, 2021 Administrative Guide
Provider communication - Ch.18, 2021 Administrative Guide
Network News: Provider news and updates - Ch.18, 2021 Administrative Guide
Network Bulletin: Policy and protocol updates - Ch.18, 2021 Administrative Guide
Medical Policy Update Bulletin - Ch.18, 2021 Administrative Guide
Other communications - Ch.18, 2021 Administrative Guide
All Savers supplement - 2021 Administrative Guide
All Savers supplement - 2021 Administrative Guide
How to contact All Savers - 2021 Administrative Guide
Capitation and/or delegation supplement- 2021 Administrative Guide
Capitation and/or delegation supplement- 2021 Administrative Guide
What is capitation? - 2021 Administrative Guide
What is delegation? - 2021 Administrative Guide
How to contact us, Capitation and/or delegation - 2021 Administrative Guide
Verifying eligibility and effective dates - 2021 Administrative Guide
Commercial eligibility, enrollment, transfers, and disenrollment- 2021 Administrative Guide
Medicare Advantage (MA) enrollment, eligibility and transfers, and disenrollment - 2021 Administrative Guide
Authorization guarantee (CA Commercial only) - 2021 Administrative Guide
Care provider responsibilities - 2021 Administrative Guide
Delegated credentialing program- 2021 Administrative Guide
Virtual Visits (Commercial HMO plans – CA only) - 2021 Administrative Guide
Virtual Visits (Medicare Advantage) - 2021 Administrative Guide
Referrals and referral contracting- 2021 Administrative Guide
Medical management - 2021 Administrative Guide
Pharmacy - 2021 Administrative Guide
Facilities - 2021 Administrative Guide
Claims processes - 2021 Administrative Guide
Claims disputes and appeals - 2021 Administrative Guide
Contractual and financial responsibilities - 2021 Administrative Guide
Capitation reports and payments - 2021 Administrative Guide
CMS premiums and adjustments - 2021 Administrative Guide
Delegate performance management program - 2021 Administrative Guide
Appeals and grievances - 2021 Administrative Guide
Empire Plan supplement - 2021 Administrative Guide
Empire Plan supplement - 2021 Administrative Guide
Applicability of this supplement - 2021 Administrative Guide
Referrals - 2021 Administrative Guide
ID cards - 2021 Administrative Guide
Prior authorization and notification requirements - 2021 Administrative Guide
Online resources and how to contact us - 2021 Administrative Guide
Health Insurance Marketplace (Exchanges) Supplement - 2021 Administrative Guide
Leased Networks - 2021 Administrative Guide
Medica HealthCare supplement - 2021 Administrative Guide
Medica HealthCare supplement - 2021 Administrative Guide
How to Contact Us - 2021 Administrative Guide
Confidentiality of Protected Health Information (PHI) - 2021 Administrative Guide
Referrals - 2021 Administrative Guide
Prior authorizations - 2021 Administrative Guide
Appeal and reconsideration processes - 2021 Administrative Guide
Member rights and responsibilities - 2021 Administrative Guide
Documentation and confidentiality of medical records - 2021 Administrative Guide
Provider reporting responsibilities - 2021 Administrative Guide
Mid-Atlantic regional supplement- 2021 Administrative Guide
Mid-Atlantic regional supplement- 2021 Administrative Guide
Provider responsibilities - 2021 Administrative Guide
Referrals - 2021 Administrative Guide
Prior authorizations - 2021 Administrative Guide
Claims process - 2021 Administrative Guide
Capitation - 2021 Administrative Guide
Neighborhood Health Partnership supplement - 2021 Administrative Guide
Neighborhood Health Partnership supplement - 2021 Administrative Guide
How to contact NHP - 2021 Administrative Guide
Discharge of a member from participating provider’s care - 2021 Administrative Guide
Laboratory services - 2021 Administrative Guide
Referrals - 2021 Administrative Guide
Utilization Management (UM) - 2021 Administrative Guide
Claims reconsiderations and appeals - 2021 Administrative Guide
Capitated health care providers - 2021 Administrative Guide
OneNet PPO supplement- 2021 Administrative Guide
OneNet PPO supplement- 2021 Administrative Guide
Who to contact - OneNet PPO - 2021 Administrative Guide
Bills process - 2021 Administrative Guide
Referrals - 2021 Administrative Guide
Provider responsibilities and workflows- 2021 Administrative Guide
Medical records standards and requirements - 2021 Administrative Guide
Quality management and health management programs- 2021 Administrative Guide
Participant rights and responsibilities - 2021 Administrative Guide
Oxford Commercial supplement - 2021 Administrative Guide
Oxford Commercial supplement - 2021 Administrative Guide
Oxford Commercial product overview- 2021 Administrative Guide
How to contact Oxford Commercial - 2021 Administrative Guide
Care provider responsibilities and standards - 2021 Administrative Guide
Referrals - 2021 Administrative Guide
Utilization management - 2021 Administrative Guide
Using non-participating health care providers or facilities - 2021 Administrative Guide
Radiology, cardiology and radiation therapy procedures - 2021 Administrative Guide
Emergencies and urgent care - 2021 Administrative Guide
Utilization reviews - 2021 Administrative Guide
Claims process - 2021 Administrative Guide
Member billing - 2021 Administrative Guide
Claims recovery, appeals, disputes and grievances - 2021 Administrative Guide
Quality assurance - 2021 Administrative Guide
Case management and disease management programs - 2021 Administrative Guide
Clinical process definitions - 2021 Administrative Guide
Member rights and responsibilities - 2021 Administrative Guide
Medical and administrative policy updates - 2021 Administrative Guide
Oxford Level-Funded plans (NJ and CT) - 2021 Administrative Guide
Oxford Level-Funded plans (NJ and CT) - 2021 Administrative Guide
How to contact Oxford Level Funded - 2021 Administrative Guide
Our claims process - 2021 Administrative Guide
How to submit your reconsideration or appeal - 2021 Administrative Guide
Preferred Care Partners Supplement - 2021 Administrative Guide
Preferred Care Partners Supplement - 2021 Administrative Guide
About Preferred Care Partners - 2021 Administrative Guide
How to contact us - 2021 Administrative Guide
Confidentiality of Protected Health Information (PHI) - 2021 Administrative Guide
Prior authorizations and referrals - 2021 Administrative Guide
Clinical coverage review - 2021 Administrative Guide
Appeal and reconsideration processes - 2021 Administrative Guide
Member rights and responsibilities - 2021 Administrative Guide
Documentation and confidentiality of medical records - 2021 Administrative Guide
Case management and disease management program information - 2021 Administrative Guide
Special needs plans, Preferred Care Partners - 2021 Administrative Guide
Care provider reporting responsibilities - 2021 Administrative Guide
River Valley Entities Supplement - 2021 Administrative Guides
River Valley Entities Supplement - 2021 Administrative Guides
Information regarding the use of this supplement - 2021 Administrative Guides
Eligibility - 2021 Administrative Guides
How to contact River Valley - 2021 Administrative Guides
Reimbursement policies - 2021 Administrative Guides
Referrals - 2021 Administrative Guides
Utilization Management - 2021 Administrative Guides
Claims process - 2021 Administrative Guides
UMR supplement - 2021 Administrative Guide
UMR supplement - 2021 Administrative Guide
How to contact UMR - 2021 Administrative Guide
Health plan identification (ID) cards - 2021 Administrative Guide
Prior authorization and notification requirements - 2021 Administrative Guide
Clinical trials, experimental or investigational services- 2021 Administrative Guide
Pharmacy and specialty pharmacy benefits - 2021 Administrative Guide
Medication therapy management - 2021 Administrative Guide
Specific protocols - 2021 Administrative Guide
Our claims process - 2021 Administrative Guide
Health and disease management - 2021 Administrative Guide
Frequently asked questions (FAQs) - 2021 Administrative Guide
UnitedHealthcare Level Funded supplement
UnitedHealthcare West supplement - 2021 Administrative Guide
UnitedHealthcare West supplement - 2021 Administrative Guide
UnitedHealthcare West information regarding our care provider website - 2021 Administrative Guide
How to contact UnitedHealthcare West resources - 2021 Administrative Guide
Care provider responsibilities - 2021 Administrative Guide
Utilization and medical management - 2021 Administrative Guide
Hospital notifications - 2021 Administrative Guide
Pharmacy network - 2021 Administrative Guide
Claims process - 2021 Administrative Guide
Care provider claims appeals and disputes - 2021 Administrative Guide
California language assistance program (California commercial plans) - 2021 Administrative Guide
Member complaints and grievances - 2021 Administrative Guide
California Quality Improvement Committee - 2021 Administrative Guide
UnitedHealthOne individual plans supplement - 2021 Administrative Guide
UnitedHealthOne individual plans supplement - 2021 Administrative Guide
How to contact UnitedHealthOne resources - 2021 Administrative Guide
Claims process - 2021 Administrative Guide
Member complaints and grievances - 2021 Administrative Guide
Glossary - 2021 Administrative Guide
Reports and Quality Programs
Reports and Quality Programs
CAHPS and the Health Outcomes Survey
Designated Diagnostic Provider
Home Health and SNF High-Performing Provider Initiative Lists
Hospital Performance Based Compensation
HouseCalls
PATH
Peer Comparison Reports
Physician Performance Based Compensation
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
UnitedHealth Premium® Program
2018/2019 Premium Methodology
New User Registration
New User Registration
Return to UnitedHealthcare Provider Portal
What Is an ID / Password Content Owner?
reg-premium-access-only
Health Plans by State
Mississippi Health Plans
UnitedHealthcare Community Plan of Mississippi Homepage
Provider Forms and References
Print
Provider Forms and References
Disclosure of Ownership, Management and Control Interest Form
Entity Disclosure of Ownership and Control Interest Form - Online Version
Individual Disclosure of Ownership and Control Interest Form - Online Version
Individual Providers Disclosure of Ownership, Controlling Interest, & Management Statement and Attestation of Criminal Convictions, Sanctions, Exclusions, Debarment or Termination
Obstetrics / Pregnancy Risk Assessment Form
(Last Modified 01.18.2019)
Prior Authorization Forms
Provider Entity Disclosure of Ownership, Controlling Interest and Management Statement