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January 1, 2021 at 12:00 PM CT

Applicable to all states except NC.

UMR supplement - 2021 UnitedHealthcare Administrative Guide

Applicability of this supplement

UMR is a wholly owned subsidiary of UnitedHealthcare, a part of UnitedHealth Group. UMR is a third-party administrator (TPA) and not an insurance company. UMR delivers solutions for self-funded employer groups to help ensure claims are paid correctly according to the member’s benefit plan. In addition to offering self-funded employer groups access to the UnitedHealthcare networks, UMR is a full-service TPA with a range of capabilities and solutions from medical claim administration to stop loss coverage and pharmacy benefits administration, to proprietary care management and wellness programs. UMR has a proprietary claims platform with dedicated customer service and does not access claims on UHCprovider.com.

UnitedHealthcare Shared Services (UHSS) is a unique service model that allows plan sponsors that self-administer their benefit plans, or already have a TPA, to access the UnitedHealthcare network and clinical programs. UHSS is NOT a leased network arrangement. It is a partnership between the customer/plan administrator and UnitedHealthcare designed to meet the needs of the customer and member.

You are subject to both the UnitedHealthcare Care Provider Administrative Guide and this UMR supplement. This supplement supersedes if it conflicts with information in the main guide. If there are additional protocols, policies or procedures online, we will direct you to that location when applicable. For protocols, policies and procedures not referenced in this supplement, refer to the appropriate chapter in the main guide.