November 17, 2022
New Hospital Services: Observation and Inpatient Policy
We’re retiring the current versions of the Observation Utilization Review Guide on Nov. 30, 2022. The new Hospital Services: Observation and Inpatient Policy goes into effect Dec. 1, 2022.
For UnitedHealthcare Community Plans, the Observation Utilization Review Guide remains in effect until the individual states review and approve the new hospital services policy. You may access the new policy for each health plan below.
- Hospital Service: Observation and Inpatient – Commercial
- Hospital Services: Observation and Inpatient – Oxford
- Hospital Services: Observation and Inpatient – UnitedHealthcare West
- Hospital Services: Observation and Inpatient – Community Plan (Pending state approval)
- Hospital Services (Outpatient, Observation, and Inpatient) – Medicare Advantage Coverage Summary
What to do
Please send all relevant clinical information when submitting a request for inpatient services to assist in our decision-making process.
Relevant clinical information includes, but is not limited to:
- Emergency room information
- Observation clinical documentation
- History and physician notes
- Any other relevant information that applies to the inpatient request
Additional resource
Learn more by reviewing the Observation and Inpatient Policy self-paced course.
Questions?
Contact your provider advocate.
