Understanding your network participation - Chapter 4, 2021 UnitedHealthcare Administrative Guide

You may already participate in benefit plans offered on the Exchange if you participate in UnitedHealthcare’s commercial benefit plans, unless the network is listed as an excluded benefit plan in your Agreement. For Compass and Charter Exchange networks, participating care providers must also have a location in the network service area to be eligible for in-network coverage. Locations listed outside of the service area may not be considered eligible for in-network benefit coverage.

As a participating care provider, you agree to give UnitedHealthcare members equal access to the treatment they need. This includes service or treatment for any Exchange member with plans in which you participate.

Reimbursement

Reimbursement for Exchange plans is the same as your commercial rates, unless your Agreement includes a specific Payment Appendix for the network name (Compass, Charter).

Health plan ID card

Example Exchange Plans ID card Example Exchange Plans ID card

This sample ID card is for illustration only. Actual information varies depending on payer, plan and other requirements.

  1. Name of the state Exchange
  2. Payer ID used for electronic data interchange
  3. Primary Care Provider information or “PCP Required” reference
  4. Referral required indicator
  5. Member’s network name
  6. Referral requirement statement
  7. Claims mailing address