- 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
The purpose of the UnitedHealthcare Medical Management Program is to determine if medical services are:
- Covered under the member’s benefit plan;
- Clinically necessary and appropriate; and
- Performed at the most appropriate setting for the member.