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Delegated Providers and Accountable Care Organizations - 2019 UnitedHealthcare Administrative Guide

Delegated Providers and Accountable Care Organizations

What is a Delegated Provider / Accountable Care Organization (ACO)?

Delegation is a process we use to give another entity the authority to perform specific functions on our behalf. We may delegate:

  1. Medical management,
  2. Credentialing,
  3. Claims,
  4. Complex case management, or
  5. Other clinical and administrative functions.

When we delegate any of these responsibilities to you, you are a Delegated Provider (referred to in this supplement as “delegated entity” or “delegate”). We remain responsible to external regulatory agencies and other entities for the performance of the delegated activities.

To become a delegate, the provider/ACO must demonstrate compliance with our established standards and best practices. Additionally, to remain a delegate, the provider/ACO must continuously comply with our standards and best practices. If the delegate is non-compliant with our standards and best practices, we may revoke any or all delegated activities.

If you are associated with a delegated medical group, IPA, or other entity, you must use their office policies and protocols.

This supplement is intended for use by participating physicians, health care providers, facilities and ancillary providers who are delegated for certain UnitedHealthcare activities. This supplement applies to all benefit plans for members whose:

  1. Medical group, IPA, or other care provider performs any of the above functions on behalf of UnitedHealthcare, or
  2. Care provider is a member of an Accountable Care Organization (ACO), where the ACO performs any of the above functions on behalf of UnitedHealthcare.