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Administrative Guides and Manuals
Administrative Guides and Manuals
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
Community Plan Care Provider Manuals
Claims, Billing and Payments
Claims, Billing and Payments
claimsLink
Electronic Payments (EPS)
UnitedHealthcare West Plan Codes Report
Revenue Cycle Management Companies
Eligibility and Benefits
Eligibility and Benefits
eligibilityLink
Demographics and Profiles
Demographics and Profiles
Attestation
My Practice Profile Tool
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
UnitedHealthcare Community Plan of Arizona Homepage
UnitedHealthcare Community Plan of Arizona Homepage
Bulletins and Newsletters
Care Provider Manuals
Claims and Payments
Payment Policy Notifications
Pharmacy Resources & Physician Administered Drugs
Pharmacy Resources & Physician Administered Drugs
Clinical Pharmacy Clinical Guidelines & Policies - UnitedHealthcare Community Plan of Arizona
Policies and Clinical Guidelines
Prior Authorization and Notification
Provider Forms, Programs and References
Provider Training
UnitedHealthcare Dual Complete® Special Needs Plans
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
UnitedHealthcare Community Plan of California Homepage
UnitedHealthcare Community Plan of California Homepage
Bulletins and Newsletters
Care Provider Manuals
Claims and Payments
Payment Policy Notifications
Pharmacy Resources and Physician Administered Drugs
Policies and Clinical Guidelines
Prior Authorization and Notification
Quality Facility Site Review Resources
Training and Education
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
UnitedHealthcare Community Plan of Colorado Homepage
UnitedHealthcare Community Plan of Colorado Homepage
Care Provider Manuals
Claims and Payments
Policies and Clinical Guidelines
Prior Authorization and Notification
UnitedHealthcare Dual Complete® Special Needs Plans
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
UnitedHealthcare Community Plan of Delaware Homepage
UnitedHealthcare Community Plan of Delaware Homepage
Bulletins and Newsletters
Care Provider Manuals
Claims and Payments
Payment Policy Notifications
Pharmacy Resources and Physician Administered Drugs
Policies and Clinical Guidelines
Prior Authorization and Notification
Provider Forms and References
UnitedHealthcare Dual Complete® Special Needs Plans
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
UnitedHealthcare Community Plan of District of Columbia Homepage
UnitedHealthcare Community Plan of District of Columbia Homepage
Care Provider Manuals
Claims and Payments
Policies and Clinical Guidelines
Prior Authorization and Notification
UnitedHealthcare Dual Complete® Special Needs Plans
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®
UnitedHealthcare Community Plan of Florida Homepage
UnitedHealthcare Community Plan of Florida Homepage
Bulletins and Newsletters
Care Provider Manuals
Claims and Payments
Payment Policy Notifications
Pharmacy Resources and Physician Administered Drugs
Policies and Clinical Guidelines
Prior Authorization and Notification
Provider Training
UnitedHealthcare Dual Complete® Special Needs Plans
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
UnitedHealthcare Community Plan of Georgia Homepage
UnitedHealthcare Community Plan of Georgia Homepage
Care Provider Manuals
Claims and Payments
Policies and Clinical Guidelines
Prior Authorization and Notification
UnitedHealthcare Dual Complete® Special Needs Plans
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
UnitedHealthcare Community Plan of Hawaii Homepage
UnitedHealthcare Community Plan of Hawaii Homepage
Bulletins and Newsletters
Care Provider Manuals
Claims and Payments
Payment Policy Notifications
Pharmacy Resources and Physician Administered Drugs
Policies and Clinical Guidelines
Prior Authorization and Notification
Provider Forms and References
Provider Training
UnitedHealthcare Dual Complete® Special Needs 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
UnitedHealthcare Community Plan of Iowa Homepage
UnitedHealthcare Community Plan of Iowa Homepage
Bulletins and Newsletters
Care Provider Manuals
Claims and Payments
Payment Policy Notifications
Pharmacy Resources and Physician Administered Drugs
Policies and Clinical Guidelines
Prior Authorization and Notification
Provider Forms and Reference Guides
Provider Training
Quality Program
UnitedHealthcare Dual Complete® Special Needs 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)
UnitedHealthcare Community Plan of Kansas Homepage
UnitedHealthcare Community Plan of Kansas Homepage
Bulletins and Newsletters
Care Provider Manuals
Claims and Payments
Payment Policy Notifications
Pharmacy Resources and Physician Administered Drugs
Policies and Clinical Guidelines
Prior Authorization and Notification
Provider Forms and References
Provider Training
UnitedHealthcare Dual Complete® Special Needs Plans
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
UnitedHealthcare Community Plan of Louisiana Homepage
UnitedHealthcare Community Plan of Louisiana Homepage
Bulletins and Newsletters
Care Provider Manuals
Claims and Payments
Payment Policy Notifications
Pharmacy Resources and Physician Administered Drugs
Policies and Clinical Guidelines
Prior Authorization and Notification
Provider Forms and References
Provider Training
UnitedHealthcare Dual Complete® Special Needs 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
UnitedHealthcare Community Plan of Maryland Homepage
UnitedHealthcare Community Plan of Maryland Homepage
Bulletins and Newsletters
Care Provider Manuals
Claims and Payments
Payment Policy Notifications
Pharmacy Resources and Physician Administered Drugs
Policies and Clinical Guidelines
Prior Authorization and Notification
Provider Forms and References
Provider Training
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
UnitedHealthcare Community Plan of Massachusetts Homepage
UnitedHealthcare Community Plan of Massachusetts Homepage
Bulletins and Newsletters
Care Provider Manuals
Claims and Payments
Payment Policy Notifications
Pharmacy Resources and Physician Administered Drugs
Policies and Clinical Guidelines
Prior Authorization and Notification
Provider Forms and References
Provider Training
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
UnitedHealthcare Community Plan of Michigan Homepage
UnitedHealthcare Community Plan of Michigan Homepage
Bulletins and Newsletters
Care Provider Manuals
Contact Us
Claims and Payments
Healthy Michigan Risk Assessment
Payment Policy Notifications
Pharmacy Resources and Physician Administered Drugs
Policies and Clinical Guidelines
Prior Authorization and Notification
Provider Forms and References
Provider Training
UnitedHealthcare Dual Complete® Special Needs 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
UnitedHealthcare Community Plan of Mississippi Homepage
UnitedHealthcare Community Plan of Mississippi Homepage
Bulletins and Newsletters
Care Provider Manuals
Claims and Payments
Payment Policy Notifications
Pharmacy Resources and Physician Administered Drugs
Policies and Clinical Guidelines
Prior Authorization and Notification
Provider Forms and References
Provider Training
UnitedHealthcare Dual Complete® Special Needs Plans
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
UnitedHealthcare Community Plan of Missouri Homepage
UnitedHealthcare Community Plan of Missouri Homepage
Bulletins and Newsletters
Care Provider Manuals
Claims and Payments
Payment Policy Notifications
Pharmacy Resources and Physician Administered Drugs
Policies and Clinical Guidelines
Prior Authorization and Notification
Provider Forms and References
Training and Education
UnitedHealthcare Dual Complete® Special Needs Plans
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)
UnitedHealthcare Community Plan of Nebraska Homepage
UnitedHealthcare Community Plan of Nebraska Homepage
Behavioral Health
Bulletins and Newsletters
Care Provider Manuals
Claims and Payments
Dual Complete (HMO-SNP) Program
Payment Policy Notifications
Pharmacy Resources and Physician Administered Drugs
Policies and Clinical Guidelines
Prior Authorization and Notification
Provider Forms and References
Training and Education
UnitedHealthcare Dual Complete® Special Needs Plans
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
UnitedHealthcare Community Plan of New Jersey Homepage
UnitedHealthcare Community Plan of New Jersey Homepage
Bulletins and Newsletters
Care Provider Manuals
Claims and Payments
Dual Complete® ONE
Managed Long-Term Care Services and Supports (MLTSS)
Payment Policy Notifications
Pharmacy Resources and Physician Administered Drugs
Policies and Clinical Guidelines
Prior Authorization and Notification
Provider Forms and References
Training and Education
UnitedHealthcare Dual Complete® Special Needs Plans
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
UnitedHealthcare Community Plan of New Mexico Homepage
UnitedHealthcare Community Plan of New Mexico 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
Prior Authorization and Notification
Provider Forms and References
Training and Education
UnitedHealthcare Dual Complete® Special Needs 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
UnitedHealthcare Community Plan of New York Homepage
UnitedHealthcare Community Plan of New York Homepage
Bulletins and Newsletters
Care Provider Manuals
Claims and Payments
Payment Policy Notifications
Pharmacy Resources and Physician Administered Drugs
Policies and Clinical Guidelines
Prior Authorization and Notification
Provider Forms and References
Training and Education
UnitedHealthcare Connected
UnitedHealthcare Dual Complete® Special Needs Plans
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
UnitedHealthcare Community Plan of North Carolina Homepage
UnitedHealthcare Community Plan of North Carolina Homepage
Care Provider Manuals
Claims and Payments
Policies and Clinical Guidelines
Prior Authorization and Notification
Training and Education
UnitedHealthcare Dual Complete® Special Needs Plans
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
UnitedHealthcare Community Plan of Ohio Homepage
UnitedHealthcare Community Plan of Ohio Homepage
Bulletins and Newsletters
Care Provider Manuals
Claims and Payments
Forms, Billing and Reference Guides
Payment Policy Notifications
Pharmacy Resources and Physician Administered Drugs
Policies and Clinical Guidelines
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® MedicareComplete® SecureHorizons® 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
Care Provider Manuals
Claims and Payments
Policies and Clinical Guidelines
Prior Authorization and Notification
Training and Education
UnitedHealthcare Dual Complete® Special Needs Plans
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
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
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® MedicareComplete®
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
Policies and Clinical Guidelines
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® 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
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
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® 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
UnitedHealthcare Community Plan of Texas Homepage
UnitedHealthcare Community Plan of Texas Homepage
Bulletins and Newsletters
Care Provider Manuals
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Administrative Guides and Manuals
2018 UnitedHealthcare Online Administrative Guide
Credentialing and Re-Credentialing - Ch.14, 2018 Administrative Guide
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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
