Applicable to all states except NC.
Welcome to the UnitedHealthcare Care Provider Administrative Guide for Commercial and Medicare Advantage (MA) products. This guide has important information on topics such as claims and prior authorizations. It also has protocol information for health care providers. This guide has useful contact information such as addresses, phone numbers and websites. More policies and electronic tools are available on UHCprovider.com.
This 2021 UnitedHealthcare Care Provider Administrative Guide (this “guide”) applies to covered services you provide to our members or the members of our affiliates* through our benefit plans insured by or receiving administrative services from us, unless otherwise noted.
This guide is effective April 1, 2021, for physicians, health care professionals, facilities and ancillary care providers currently participating in our Commercial and MA networks. It is effective now for care providers who join our network on or after Jan. 1, 2021. This guide is subject to change. We frequently update content in our effort to support our health care provider networks.
Terms and definitions as used in this guide:
MA policies, protocols and information in this guide apply to covered services you provide to UnitedHealthcare MA members, including Erickson Advantage members and most UnitedHealthcare Dual Complete members, excluding UnitedHealthcare Medicare Direct members. We indicate if a particular section does not apply to such MA members.
If there is a conflict or inconsistency between a Regulatory Requirements Appendix attached to your Agreement and this guide, the provisions of the Regulatory Requirements Appendix controls for benefit plans within the scope of that appendix.
If there is an inconsistency between your Agreement and this guide, your Agreement controls (except where your Agreement provides protocols for our affiliates). If those protocols are in a supplement to this guide, those protocols control for services you give to a member subject to that supplement.
Per your Agreement, you must comply with protocols. Payment will be denied, in whole or in part, for failure to comply with a protocol.