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  • Administrative Guides
    • Administrative Guides
    • 2018 UnitedHealthcare Online Administrative Guide
      • 2018 UnitedHealthcare Online Administrative Guide
      • Welcome to UnitedHealthcare 2018 Administrative Guide
      • Introduction - Chapter 1, 2018 UnitedHealthcare Administrative Guide
        • Introduction - Chapter 1, 2018 UnitedHealthcare Administrative Guide
        • Manuals and Benefit Plans Referenced in the Guide
        • Benefit Plans Subject to this Guide
        • Benefit Plans Not Subject to this Guide
        • Resources and How to Contact Us
      • Provider Responsibilities and Standards
        • Provider Responsibilities and Standards
        • Electronic Data Interchange (EDI)
        • Verifying Eligibility, Benefits and your Network Participation
        • Healthcare Identification (ID) Card
        • Access Standards
        • Primary Care Physicians (PCP) Responsibilities
        • Demographic Changes
        • Administrative Terminations for Inactivity
        • Continuity of Care Following Termination of Your Participation
        • Medicare Opt-Out
        • Additional Requirements
        • Filing a Lawsuit by a Member
      • Commercial Products
        • Commercial Products
        • Commercial Product Overview
        • Benefit Plan Types
        • Primary Care Physicians (PCP) Selection
        • HRAs and HSAs Consumer-Driven Health Benefit Plans
      • Medicare Products
        • Medicare Products
        • Medicare Product Overview
        • Coverage Summaries and Policy Guidelines for MA Members
        • Medicare Supplement Benefit Plans
      • 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
        • Facility Denial Process
        • 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
      • Specialty Pharmacy and Medicare Advantage Pharmacy
        • Specialty Pharmacy and Medicare Advantage Pharmacy
        • Commercial Pharmacy
        • Specialty Pharmacy Requirements for Certain Commercial Specialty Medications
        • MA Pharmacy
        • Drug Utilization Review Program
        • Medication Therapy Management (MTM)
        • Transition Policy
      • Specific Protocols
        • Specific Protocols
        • Air Ambulance, Fixed-Wing Non-Emergency Transport
        • Laboratory Benefit Management Program Administered by BeaconLBSTM (Florida only)
        • Laboratory Services Protocol
        • Non-Participating Providers Consent Form
        • Nursing Home and Assisted Living Plans
      • 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
        • Hospital Responsibilities
        • 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 Disputes - Concern or Complaint
        • 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
        • Notice of Medicare Non-Coverage (NOMNC)
      • Medical Records Standards and Requirements
      • Health and Disease Management
        • Health and Disease Management
        • Health Management Programs
        • Case Management
        • Wellness and Behavioral Health Programs
        • Consumer Transparency Tools: MyHealthcareCostEstimator (myHCE)
        • Behavior 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
        • Initial Credentialing Process
        • Recredentialing 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
        • Prevention and Detection
        • 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
      • Capitated Providers
        • Capitated Providers
        • Capitated Providers, Capitation and/or Delegation Supplement
        • Delegated Providers and Accountable Care Organizations - Capitation and/or Delegation Supplement
        • How to Contact Us, Capitation and/or Delegation Supplement
        • Verifying Eligibility and Effective Dates, Capitation and/or Delegation Supplement
        • Commercial Eligibility, Enrollment, Transfers and Disenrollment - Capitation and/or Delegation Supplement
        • Medicare Advantage (MA) Enrollment, Eligibility and Transfers, and Disenrollment - Capitation and/or Delegation Supplement
        • Eligibility/Authorization Gaurantee
        • Provider Responsibilities
        • Delegated Credentialing Program
        • Virtual Visits (Commercial HMO Plans CA only)
        • Referrals & Referral Contracting
        • Medical Management
        • Pharmacy
        • Facilities
        • Claims Processes
        • Medicare Advantage (MA Delegated or Capitated)
        • Claims Disputes and Appeals
        • Contractual and Financial Responsibilities
        • Capitation Payments and Reporting
        • CMS Premiums and Adjustments
        • Appeals and Grievances
      • Leased Networks
      • Medica Healthcare Supplement
        • Medica Healthcare Supplement
        • How to Contact Us
        • Confidentiality of Protected Health Information (PHI)
        • Prior Authorizations and Referrals
        • Appeals and Reconsideration Processes
        • Member Rights and Responsibilities
        • Documentation and Confidentiality of Medical Records
        • Provider Reporting Responsibilities
      • Mid-Atlantic Regional Supplement
        • Mid-Atlantic Regional Supplement
        • Provider Responsibilities
        • Referrals
        • Prior Authorizations
        • Capitation
        • Claims Process
      • 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
        • Discontinuation of the OneNet PPO Medical Network Product
        • How to Contact OneNet PPO
        • OneNet General Provider Administration Requirements
        • Referrals
        • Utilization Review Components for Workers' Compensation
        • Workers' Compensation Claims Process
        • Resolving Disputes
        • Medical Records Standards and Requirements
        • Quality Management and Health Management Programs
        • Participant Rights and Responsibilities
      • Oxford Commercial Supplement
        • Oxford Commercial Supplement
        • Oxford Commercial Product Overview
        • How to Contact Oxford Commercial
        • Care Provider Responsibilities and Standards
        • Referrals
        • Utilization Management
        • Using Non-Participating Health Care Providers or Facilities
        • Radiology and Cardiology Procedures
        • Emergencies and Urgent Care
        • Utilization Reviews
        • Claims Process
        • Member Billing
        • Claims Recovery, Appeals, Disputes and Grievances
        • Quality Assurance
        • Case Management and Disease Management Programs
        • Clinical Process Definitions
        • Member Rights and Responsibilities
        • Medical and Administrative Policy Updates
      • Preferred Care Partners Supplement
        • Preferred Care Partners Supplement
        • About Preferred Care Partners
        • How to Contact Us
        • Confidentiality of Protected Health Information (PHI)
        • Prior Authorizations and Referrals
        • Clinical Coverage Review
        • Appeal & Reconsideration Processes
        • Member Rights and Responsibilities
        • Documentation and Confidentiality of Medical Records
        • Case Management and Disease Management Program Information
        • Special Needs Plans
        • Care Provider Reporting Responsibilities
      • River Valley Entities Supplement
        • River Valley Entities Supplement
        • Eligibility
        • How to Contact River Valley
        • Reimbursement Policies
        • Referrals
        • Utilization Management
        • Claims Process
      • UnitedHealthcare West Supplement
        • UnitedHealthcare West Supplement
        • UnitedHealthcare West Information Regarding our Care Provider Website
        • How to Contact UnitedHealthcare West Resources - 2018 UnitedHealthcare Administrative Guide
        • Care Provider Responsibilities
        • Utilization and Medical Management
        • Hospital Notificiations
        • Pharmacy Network
        • Claims Process
        • CareProvider Claims Appeals and Disputes
        • California Language Assistance Program (California Commercial Plans)
        • Member Complaints & Grievances
        • California Quality Improvement Committee
      • UnitedHealthOne Individual Plans Supplement
        • UnitedHealthOne Individual Plans Supplement
        • How to Contact UnitedHealthOne Resources
        • Claims Process
        • Member Complaints & Grievances
      • Glossary
  • Claims, Billing and Payments
    • Claims, Billing and Payments
    • claimsLink
    • Electronic Payments (EPS)
  • Eligibility and Benefits
    • Eligibility and Benefits
    • eligibilityLink
  • Demographics and Profiles
    • Demographics and Profiles
    • Attestation
    • My Practice Profile App
  • Find a Care Provider
    • Find a Care Provider
    • CA Ancillary Care Providers
    • Relative Cost of Network Providers Tool
  • Health Plans by State
    • Health Plans by State
    • Tiered Benefit Plans
    • AL Health Plans
      • AL Health Plans
      • AL Commercial Plans
      • AL Medicare Advantage Plans
        • AL Medicare Advantage Plans
        • AL AARP® MedicareComplete®
        • AL Dual Complete® SNP
        • AL Group Medicare Advantage Plans
        • AL Nursing Home Plan
    • AK Health Plans
      • AK Health Plans
      • AK Commercial Health Plans
    • AZ Health Plans
      • AZ Health Plans
      • AZ Commercial Health Plans
      • AZ Medicare Advantage Health Plans
        • AZ Medicare Advantage Health Plans
        • AZ AARP® MedicareComplete®
        • AZ Assisted Living Plan
        • AZ Dual Complete® SNP
        • AZ Group Medicare Advantage Plans
        • AZ UnitedHealthcare® MedicareDirect (PFFS)
        • AZ Nursing Home Plan
    • AR Health Plans
      • AR Health Plans
      • AR Commercial Health Plans
      • AR Medicare Advantage Health Plans
        • AR Medicare Advantage Health Plans
        • AR AARP® MedicareComplete®
        • AR Care Improvement Plus Plans
        • AR Care Improvement Plus® SNP Plans
        • AR Group Medicare Advantage Plans
    • CA Health Plans
      • CA Health Plans
      • CA Commercial Health Plans
      • CA Medicare Advantage Health Plans
        • CA Medicare Advantage Health Plans
        • CA AARP® MedicareComplete® SecureHorizons® Plans
        • California Group Medicare Advantage Plans
        • CA UnitedHealthcare® MedicareDirect (PFFS)
        • CA Sharp SecureHorizons Plan
    • CO Health Plans
      • CO Health Plans
      • CO Commercial Health Plans
      • CO Medicare Advantage Health Plans
        • CO Medicare Advantage Health Plans
        • CO AARP® MedicareComplete® SecureHorizons® Plans
        • Colorado Assisted Living Plan
        • CO Erickson Advantage® Freedom / Signature Plans
        • CO Erickson Advantage® SNP Plans
        • CO Dual Complete® SNP
        • CO Group Medicare Advantage Plans
        • CO Nursing Home Plan
    • CT Health Plans
      • CT Health Plans
      • CT Commercial Health Plans
      • CT Medicare Advantage Health Plans
        • CT Medicare Advantage Health Plans
        • CT AARP® MedicareComplete®
        • CT Assisted Living Plan
        • CT MedicareComplete Plans
        • CT Nursing Home Plan
    • DE Health Plans
      • DE Health Plans
      • DE Commercial Health Plans
      • DE Medicare Advantage Health Plans
        • DE Medicare Advantage Health Plans
        • DE Assisted Living Plan
        • DE Dual Complete® SNP
        • DE Group Medicare Advantage Plans
        • DE Nursing Home Plan
    • DC Health Plans
      • DC Health Plans
      • DC Commercial Health Plans
      • DC Medicare Advantage Health Plans
        • DC Medicare Advantage Health Plans
        • DC Assisted Living Plan
        • DC Dual Complete® SNP
        • DC Group Medicare Advantage Plans
        • DC Nursing Home Plan
    • FL Health Plans
      • FL Health Plans
      • FL Commercial Health Plans
      • FL Medicare Advantage Health Plans
        • FL Medicare Advantage Health Plans
        • FL AARP® MedicareComplete®
        • FL Assisted Living Plan
        • FL Dual Complete® SNP
        • FL Group Medicare Advantage Plans
        • FL Medica HealthCare Plans
        • FL Nursing Home Plan
        • FL Preferred Choice Medicare Advantage Plans
        • Florida Preferred Care Special Needs Plans
        • FL UnitedHealthcare The Villages MedicareComplete®
    • GA Health Plans
      • GA Health Plans
      • GA Commercial Health Plans
      • GA Medicare Advantage Health Plans
        • GA Medicare Advantage Health Plans
        • GA AARP® MedicareComplete®
        • GA Care Improvement Plus Plans
        • GA Care Improvement Plus® SNP
        • GA Dual Complete® SNP
        • GA Group Medicare Advantage Plans
        • GA UnitedHealthcare® MedicareDirect (PFFS)
        • GA Nursing Home Plan
    • HI Health Plans
      • HI Health Plans
      • HI Commercial Health Plans
      • HI Medicare Advantage Health Plans
        • HI Medicare Advantage Health Plans
        • HI AARP® MedicareComplete®
        • HI Dual Complete® SNP
        • HI Group Medicare Advantage Plans
    • ID Health Plans
      • ID Health Plans
      • ID Commercial Health Plans
      • ID Medicare Advantage Health Plans
        • ID Medicare Advantage Health Plans
        • ID AARP® MedicareComplete®
        • ID Group Medicare Advantage Plans
    • IL Health Plans
      • IL Health Plans
      • IL Commercial Health Plans
      • IL Medicare Advantage Health Plans
        • IL Medicare Advantage Health Plans
        • IL AARP® MedicareComplete®
        • IL Group Medicare Advantage Plans
        • IL MedicareComplete Plans
        • IL Nursing Home Plan
    • IN Health Plans
      • IN Health Plans
      • IN Commercial Health Plans
      • IN Medicare Advantage Health Plans
        • IN Medicare Advantage Health Plans
        • IN AARP® MedicareComplete®
        • IN Group Medicare Advantage Plans
        • IN Nursing Home Plan
    • IA Health Plans
      • IA Health Plans
      • IA Commercial Health Plans
      • IA Medicare Advantage Health Plans
        • IA Medicare Advantage Health Plans
        • IA AARP® MedicareComplete®
        • IA Dual Complete® SNP
        • IA Group Medicare Advantage Plans
    • KS Health Plans
      • KS Health Plans
      • KS Commercial Health Plans
      • KS Medicare Advantage Health Plans
        • KS Medicare Advantage Health Plans
        • KS AARP® MedicareComplete®
        • KS Dual Complete® SNP
        • KS Erickson Advantage® Freedom/Signature Plans
        • KS Erickson Advantage® SNP Plans
        • KS Group Medicare Advantage Plans
        • KS UnitedHealthcare® MedicareDirect (PFFS)
    • KY Health Plans
      • KY Health Plans
      • KY Commercial Health Plans
      • KY Medicare Advantage Health Plans
        • KY Medicare Advantage Health Plans
        • KY AARP® MedicareComplete®
        • KY Group Medicare Advantage Plans
        • KY UnitedHealthcare® MedicareDirect (PFFS)
    • LA Health Plans
      • LA Health Plans
      • LA Commercial Health Plans
      • LA Medicare Advantage Health Plans
        • LA Medicare Advantage Health Plans
        • LA AARP® MedicareComplete®
        • LA Dual Complete® SNP
        • LA Group Medicare Advantage Plans
    • ME Health Plans
      • ME Health Plans
      • Maine Commercial Health Plans
      • ME Medicare Advantage Health Plans
        • ME Medicare Advantage Health Plans
        • Maine AARP® MedicareComplete®
        • Maine Group Medicare Advantage Plans
        • Maine Nursing Home Plan
    • MD Health Plans
      • MD Health Plans
      • Maryland Commercial Health Plans
      • MD Medicare Advantage Health Plans
        • MD Medicare Advantage Health Plans
        • Maryland Assisted Living Plan
        • Maryland Erickson Advantage® Freedom/Signature Plans
        • Maryland Erickson Advantage® SNP Plans
        • Maryland Group Medicare Advantage Plans
        • Maryland Nursing Home Plan
    • MA Health Plans
      • MA Health Plans
      • Massachusetts Commercial Health Plans
      • MA Medicare Advantage Health Plans
        • MA Medicare Advantage Health Plans
        • Massachusetts AARP® MedicareComplete®
        • Massachusetts Erickson Advantage® Freedom/Signature Plans
        • Massachusetts Erickson Advantage® SNP Plans
        • Massachusetts Group Medicare Advantage Plans
        • Massachusetts Nursing Home Plan
        • Massachusetts Senior Care Options
    • Michigan Health Plans
      • Michigan Health Plans
      • Michigan Commercial Health Plans
      • MI Medicare Advantage Health Plans
        • MI Medicare Advantage Health Plans
        • Michigan Erickson Advantage® Freedom/Signature Plans
        • Michigan Erickson Advantage® SNP Plans
        • MI Dual Complete® SNP
        • Michigan Group Medicare Advantage Plans
    • Minnesota Health Plans
      • Minnesota Health Plans
      • Minnesota Commercial Health Plans
    • Mississippi Health Plans
      • Mississippi Health Plans
      • Mississippi Commercial Health Plans
      • MS Medicare Advantage Health Plans
        • MS Medicare Advantage Health Plans
        • Mississippi Dual Complete® SNP
    • Missouri Health Plans
      • Missouri Health Plans
      • Missouri Commercial Health Plans
      • MO Medicare Advantage Health Plans
        • MO Medicare Advantage Health Plans
        • Missouri AARP® MedicareComplete®
        • Missouri Care Improvement Plus Plans
        • Missouri Care Improvement Plus Silver Gold Dual Plans
        • MO Dual Complete® SNP
        • Missouri Group Medicare Advantage Plans
        • Missouri UnitedHealthcare® MedicareDirect (PFFS)
        • Missouri Nursing Home Plan
    • Montana Health Plans
      • Montana Health Plans
      • Montana Commercial Health Plans
      • MT Medicare Advantage Health Plans
        • MT Medicare Advantage Health Plans
        • Montana UnitedHealthcare® MedicareDirect (PFFS)
    • Nebraska Health Plans
      • Nebraska Health Plans
      • Nebraska Commercial Health Plans
      • NE Medicare Advantage Health Plans
        • NE Medicare Advantage Health Plans
        • Nebraska AARP® MedicareComplete®
        • NE Dual Complete® SNP
        • Nebraska Group Medicare Advantage Plans
        • Nebraska UnitedHealthcare® MedicareDirect (PFFS)
    • Nevada Health Plans
      • Nevada Health Plans
      • Nevada Commercial Health Plans
      • NV Medicare Advantage Health Plans
        • NV Medicare Advantage Health Plans
        • Nevada AARP® MedicareComplete®
        • Nevada Senior Dimensions® of Nevada
    • New Hampshire Health Plans
      • New Hampshire Health Plans
      • New Hampshire Commercial Health Plans
      • NH Medicare Advantage Health Plans
        • NH Medicare Advantage Health Plans
        • New Hampshire AARP® MedicareComplete®
        • New Hampshire Group Medicare Advantage Plans
        • New Hampshire UnitedHealthcare® MedicareDirect (PFFS)
        • New Hampshire Nursing Home Plan
    • New Jersey Health Plans
      • New Jersey Health Plans
      • New Jersey Commercial Health Plans
      • NJ Medicare Advantage Health Plans
        • NJ Medicare Advantage Health Plans
        • New Jersey AARP® MedicareComplete®
        • New Jersey Erickson Advantage® Freedom/Signature Plans
        • New Jersey Erickson Advantage® SNP Plans
        • New Jersey Dual Complete® SNP
        • New Jersey Group Medicare Advantage Plans
        • New Jersey Nursing Home Plan
    • New Mexico Health Plans
      • New Mexico Health Plans
      • New Mexico Commercial Health Plans
      • NM Medicare Advantage Health Plans
        • NM Medicare Advantage Health Plans
        • New Mexico AARP® MedicareComplete®
        • New Mexico Dual Complete® SNP
        • New Mexico Group Medicare Advantage Plans
    • New York Health Plans
      • New York Health Plans
      • New York Commercial Health Plans
      • NY Medicare Advantage Health Plans
        • NY Medicare Advantage Health Plans
        • New York AARP® MedicareComplete®
        • NY Dual Complete Plan
        • New York Group Medicare Advantage Plans
        • New York MedicareComplete Plans
        • New York Nursing Home Plan
    • North Carolina Health Plans
      • North Carolina Health Plans
      • North Carolina Commercial Health Plans
      • NC Medicare Advantage Health Plans
        • NC Medicare Advantage Health Plans
        • North Carolina AARP® MedicareComplete®
        • North Carolina Assisted Living Plan
        • North Carolina Dual Complete® SNP
        • North Carolina Erickson Advantage® Freedom/Signature Plans
        • North Carolina Erickson Advantage® SNP Plans
        • North Carolina Group Medicare Advantage Plans
        • North Carolina Nursing Home Plan
    • North Dakota Health Plans
      • North Dakota Health Plans
      • North Dakota Commercial Health Plans
    • Ohio Health Plans
      • Ohio Health Plans
      • Ohio Commercial Health Plans
      • OH Medicare Advantage Health Plans
        • OH Medicare Advantage Health Plans
        • Ohio AARP® MedicareComplete®
        • Ohio Assisted Living Plan
        • Ohio Dual Complete® SNP
        • Ohio Group Medicare Advantage Plans
        • Ohio Nursing Home Plan
    • Oklahoma Health Plans
      • Oklahoma Health Plans
      • Oklahoma Commercial Health Plans
      • OK Medicare Advantage Health Plans
        • OK Medicare Advantage Health Plans
        • Oklahoma AARP® MedicareComplete® SecureHorizons® Plans
        • OK Dual Complete® SNP
        • Oklahoma Group Medicare Advantage Plans
        • Oklahoma UnitedHealthcare® MedicareDirect (PFFS)
    • Oregon Health Plans
      • Oregon Health Plans
      • Oregon Commercial Health Plans
      • OR Medicare Advantage Health Plans
        • OR Medicare Advantage Health Plans
        • Oregon AARP® MedicareComplete®
        • 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® MedicareComplete®
        • Pennsylvania Assisted Living Plan
        • Pennsylvania Dual Complete® SNP
        • Pennsylvania Erickson Advantage® SNP Plans
        • Pennsylvania Erickson Advantage® Freedom/Signature Plans
        • Pennsylvania Group Medicare Advantage Plans
        • Pennsylvania Nursing Home Plan
    • 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® MedicareComplete®
        • Rhode Island Assisted Living Plan
        • Rhode Island Dual Complete® SNP
        • Rhode Island Group Medicare Advantage Plans
        • Rhode Island Nursing Home Plan
    • SC Health Plans
      • SC Health Plans
      • SC Commercial Health Plans
      • SC Medicare Advantage Health Plans
        • SC Medicare Advantage Health Plans
        • SC AARP® MedicareComplete®
        • SC Care Improvement Plus Plans
        • SC Care Improvement Plus® SNP
        • SC Group Medicare Advantage Plans
        • SC Nursing Home Plan
    • SD Health Plans
      • SD Health Plans
      • SD Commercial Health Plans
    • TN Health Plans
      • TN Health Plans
      • TN Commercial Health Plans
      • TN Medicare Advantage Health Plans
        • TN Medicare Advantage Health Plans
        • TN AARP® MedicareComplete®
        • TN Dual Complete® SNP
        • TN Group Medicare Advantage Plans
    • TX Health Plans
      • TX Health Plans
      • TX Commercial Health Plans
      • TX Medicare Advantage Health Plans
        • TX Medicare Advantage Health Plans
        • TX AARP® MedicareComplete® Plans
        • TX Care Improvement Plus Plans
        • TX Care Improvement Plus® SNP
        • TX UnitedHealthcare® Chronic Complete Special Needs Plans
        • TX Dual Complete® SNP
        • TX Erickson Advantage® Freedom/Signature Plans
        • TX Erickson Advantage® SNP Plans
        • TX Group Medicare Advantage Plans
        • TX UnitedHealthcare® MedicareDirect (PFFS)
        • TX Nursing Home Plan
    • UT Health Plans
      • UT Health Plans
      • UT Commercial Health Plans
      • UT Medicare Advantage Health Plans
        • UT Medicare Advantage Health Plans
        • UT AARP® MedicareComplete®
        • UT Group Medicare Advantage Plans
        • Utah MedicareComplete® Plans
    • VT Health Plans
      • VT Health Plans
      • VT Commercial Health Plans
      • VT Medicare Advantage Health Plans
        • VT Medicare Advantage Health Plans
        • VT AARP® MedicareComplete®
        • VT Group Medicare Advantage Plans
        • VT UnitedHealthcare® MedicareDirect (PFFS)
    • VA Health Plans
      • VA Health Plans
      • Virginia Commercial Health Plans
      • VA Medicare Advantage Health Plans
        • VA Medicare Advantage Health Plans
        • Virginia AARP® MedicareComplete®
        • Virginia Erickson Advantage® Freedom/Signature Plans
        • Virginia Erickson Advantage® SNP Plans
        • VA Dual Complete® SNP
        • Virginia Group Medicare Advantage Plans
        • Virginia UnitedHealthcare® MedicareDirect (PFFS)
        • Virginia Nursing Home Plan
    • WA Health Plans
      • WA Health Plans
      • Washington Commercial Health Plans
      • WA Medicare Advantage Health Plans
        • WA Medicare Advantage Health Plans
        • Washington AARP® MedicareComplete®
        • Washington Assisted Living Plan
        • Washington Dual Complete® SNP
        • Washington Group Medicare Advantage Plans
        • Washington Nursing Home Plan
    • WV Health Plans
      • WV Health Plans
      • West Virginia Commercial Health Plans
      • WV Medicare Advantage Health Plans
        • WV Medicare Advantage Health Plans
        • West Virginia Group Medicare Advantage Plans
        • West Virginia AARP® MedicareComplete®
    • WI Health Plans
      • WI Health Plans
      • Wisconsin Commercial Health Plans
      • WI Medicare Advantage Health Plans
        • WI Medicare Advantage Health Plans
        • Wisconsin AARP® MedicareComplete®
        • Wisconsin Assisted Living Plan
        • Wisconsin Dual Complete® SNP
        • Wisconsin Care Improvement Plus Plans
        • Wisconsin Care Improvement Plus Gold Rx Plans
        • Wisconsin Group Medicare Advantage Plans
        • Wisconsin Nursing Home Plan
    • 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
      • Oxford Policies
      • SignatureValue / UHCBPCa Benefit Interpretation Policies
      • SignatureValue / UHCBPCa Medical Management Guidelines
    • Dental Policies
    • Laboratory Benefit Management Program
      • Laboratory Benefit Management Program
      • Lab Benefit Medical Policies
      • Lab Benefit Clinical Guidelines
      • Program Resources and Administrative Protocols
    • 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
  • Prior Authorization and Notification
    • Prior Authorization and Notification
    • Advance Notification and Plan Requirement Resources
    • Cardiology
    • Clinical Pharmacy and Specialty Drugs
      • Clinical Pharmacy and Specialty Drugs
      • Clinical Pharmacy Prior Authorization, Notification and Medical Necessity Requirements
      • Clinical Program Drug Step Therapy
      • Drug Lists, Supply Limits and Specialty Pharmacy
      • PreCheck MyScript App
    • Genetic and Molecular Lab Testing Notification/Prior Authorization
    • Oncology
      • Oncology
      • Avastin Expanded NCCN Review
      • BRCA Testing Prior Authorization
      • Intensity Modulated Radiation Therapy
      • Medicare Advantage Outpatient Injectable Chemotherapy Notification
      • Medicare Advantage Therapeutic Radiation
      • NCCN Compendium - Free Access
      • Prior Authorization for Outpatient Injectable Chemotherapy and Colony-Stimulating Factors
      • UnitedHealthcare Cancer Support Program
    • PreCheck MyScript App
    • Prior Authorization and Notification App
    • Prior Authorization and Notification Program Summary
    • Utilization Review Statistics
    • Radiology
  • Referrals
    • Referrals
    • EDI 278
    • eligibilityLink App
    • referralLink App
  • Reports and Quality Programs
    • Reports and Quality Programs
    • Hospital Performance
    • PATH
    • Peer Comparison Reports
    • Physician Performance
    • Quality-Based Physician Incentive Program (QPIP)
    • Star Ratings Program
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  4. Credentialing and Re-Credentialing - Ch.14, 2018 Administrative Guide
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  • Credentialing and Re-Credentialing - Ch.14, 2018 Administrative Guide
  • Credentialing/Profile Reporting Requirements - Ch.14, 2018 Administrative Guide
  • Care Provider Rights Related to the Credentialing Process - Ch.14, 2018 Administrative Guide
  • Initial Credentialing Process - Ch.14, 2018 Administrative Guide
  • Recredentialing Process - Ch.14, 2018 Administrative Guide
  • Credentialing Committee Decision Making Process (Non-Delegated) - Ch.14, 2018 Administrative Guide
  • Monitoring of All Network Care Providers - Ch.14, 2018 Administrative Guide

Credentialing and Re-Credentialing - Chapter 14, 2018 UnitedHealthcare Administrative Guide

  • Credentialing/Profile Reporting Requirements
  • Care Provider Rights Related to the Credentialing Process
  • Initial Credentialing Process
  • Recredentialing Process
  • Credentialing Committee Decision Making Process (Non-Delegated)
  • Monitoring of All Network Care Providers
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