Manuals and benefit plans referenced in the guide - Chapter 1, 2022 UnitedHealthcare Administrative Guide

Some benefit plans included under your Agreement may be subject to requirements found in other health care provider guides or manuals or to the supplements found in the second half of this guide.

This section provides information about some of the most common UnitedHealthcare products. Your Agreement may use “benefit contract types,” “benefit plan types” or a similar term to refer to our products.

Quick tip: Individual Exchange

Visit uhcprovider.com/plans for more information about our products and Individual Exchange benefit plans offered by state.

If a member presents a health plan ID card with a product name you are not familiar with, use UnitedHealthcare’s Provider Portal tools to quickly find information on the plan. You may also call us at 1-877-842-3210 or Exchange Provider Services at 1-888-478-4760.

You are subject to the provisions of additional guides when providing covered services to a member of those benefit plans, as described in your Agreement and in the following table. We may make changes to health care provider guides, supplements and manuals that relate to protocol and payment policy changes.

We may change the location of a website, a benefit plan name, branding or the member health plan ID card. We inform you of those changes through one of our health care provider communications resources.

Benefit plans subject to this guide

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Plan name:

All Savers:

All Savers Insurance Company

Location of most members subject to additional guides:

All markets

Location of plan information:

All Savers Supplement to this guide

myallsaversconnect.com

uhcprovider.com

 

Plan name:

Empire Plan

Location of most members subject to additional guides:

All markets outside of NY* and national health care providers; Primary concentrations in: AZ, CA, CT, DE, FL, GA, MA, MD, NC, NJ, NV, PA, SC, TN, TX, VA

Health plan ID card indicates NYSHIP The Empire Plan and references UnitedHealthcare logo on the back

*In the NY markets, there are a limited number of health care providers with the Empire Plan specifically added to their UnitedHealthcare Agreement. Otherwise, we have a separate health care provider network for Empire Plan members in NY.

Location of plan information:

Empire Plan supplement

uhcprovider.com

Plan name:

Exchanges

Location of most members subject to additional guides:

AL, AZ, FL, GA, IL, LA, MD, MI, NC, OK, TN, TX, VA, WA

Location of plan information:

Chapter 4: Individual Exchange Plans to this guide.

uhcprovider.com

Plan name:

MDIPA:

MD Individual Practice Association, Inc

Location of most members subject to additional guides:

DC, DE, MD, VA, WV, 

Some counties in: Southeastern PA

Location of plan information:

Mid-Atlantic Regional Supplement to this guide.

uhcprovider.com

Plan name:

Capitated and/or Delegated Providers (Commercial and MA)

Location of most members subject to additional guides:

All markets

Location of plan information:

Capitation and/or Delegation Supplement to this guide.

Plan name:

NHP: 

Neighborhood Health Partnership, Inc.

Location of most members subject to additional guides:

FL

Location of plan information:

Neighborhood Health Partnership Supplement to this guide.

uhcprovider.com

Plan name:

OCI:

Optimum Choice Inc.

Location of most members subject to additional guides:

DC, DE, MD, VA, WV, 

Some counties in: PA

Location of plan information:

Mid-Atlantic Regional Supplement to this guide.

uhcprovider.com

Plan name:

OneNet PPO

Location of most members subject to additional guides:

DC, DE, FL, GA, MD, NC, PA, SC, TN, VA, WV

Location of plan information:

OneNet PPO Supplement to this guide.

uhcprovider.com

Plan name:

Oxford:

  • Oxford Health Plans, LLC
  • Oxford Health Insurance, Inc.
  • Investors Guaranty Life Insurance Company, Inc.
  • Oxford Health Plans (NY), Inc.
  • Oxford Health Plans (NJ), Inc.
  • Oxford Health Plans (CT), Inc.
  • Oxford Level Funded Plans (NJ, CT)

Location of most members subject to additional guides:

CT, NJ, NY (except upstate)

Some counties in: PA.

Location of plan information:

Oxford Commercial Supplement to this guide.

For commercial benefits: uhcprovider.com 

For Medicare benefits: uhcprovider.com

Plan name:

Preferred Care Network (formerly Medica HealthCare)

Location of most members subject to additional guides:

FL counties: Broward and Miami-Dade

Location of plan information:

Preferred Care Network Supplement to this guide.

uhcprovider.com

Plan name:

Preferred Care Partners

Location of most members subject to additional guides:

FL counties: Broward, Miami-Dade and Palm Beach

Location of plan information:

Preferred Care Partners Supplement to this guide.

uhcprovider.com

Plan name:

River Valley: 

  • UnitedHealthcare Services Company of the River Valley, Inc.
  • UnitedHealthcare Plan of the River Valley, Inc.
  • UnitedHealthcare Insurance Company of the River Valley

Location of most members subject to additional guides:

Parts of AR, GA, IA, IL TN, WI, VA

Your UnitedHealthcare contract specifically references River Valley or John Deere Health protocols or guides; and

You are located in AR, GA, IA, TN, VA, WI or these counties in Illinois: Jo Daviess, Stephenson, Carroll, Ogle, Mercer, Whiteside, Lee, Rock Island, Henry, Bureau, Putnam, Henderson, Warren, Knox, Stark, Marshall, Livingston, Hancock, McDonough, Fulton, Peoria, Tazewell, Woodford, McLean; and

You are providing services to a River Valley Commercial member and not a River Valley Medicare Advantage, Medicaid or CHIP member.

Note: River Valley also offers benefit plans in LA, NC, OH and SC, but the River Valley Additional Guide does not apply to those benefit plans.

Location of plan information:

River Valley Entities Supplement to this guide.

uhcprovider.com

Plan name:

Sierra or Health Plan of Nevada:

  • Sierra Health and Life Insurance Co., Inc.
  • Health Plan of Nevada, Inc.
  • Sierra Healthcare Options, Inc.

Location of most members subject to additional guides:

Outside NV only:

The health plan ID card identifies the Sierra or Health Plan of Nevada members who access the UnitedHealthcare network outside of Nevada, and includes the following reference:

UnitedHealthcare Choice Plus Network Outside Nevada.

Location of plan information:

Services rendered outside of Nevada to Sierra or Health Plan of Nevada members with the health plan ID card reference described in this row are subject to your UnitedHealthcare Agreement and to this guide unless you are in Arizona or Utah and have a contract directly with Sierra or Health Plan of Nevada.

Plan name:

UMR:

  • UMR
  • UnitedHealthcare Shared Services (UHSS)

Location of most members subject to additional guides:

All markets

Location of plan information:

UMR supplement to this guide.

umr.com

Plan name:

UnitedHealthcare Level Funded 

(previously sold under the name All Savers® Alternate Funding)

Location of most members subject to additional guides:

December 2020: AL, SD, ND, DE

September 2021: All markets

Location of plan information:

UnitedHealthcare Level Funded supplement to this guide.

uhcprovider.com

Plan name:

UnitedHealthcare West: 

(Formerly referenced in this guide as “PacifiCare”)

  • UHC of California dba UnitedHealthcare of California (hereinafter referred to as UnitedHealthcare of California)
  • UnitedHealthcare Benefits Plan of California
  • UnitedHealthcare of Oklahoma, Inc.
  • UnitedHealthcare of Oregon, Inc.
  • UnitedHealthcare Benefits of Texas, Inc.*

* PacifiCare of Arizona, PacifiCare of Colorado and PacifiCare of Nevada are now referenced as UnitedHealthcare Benefits of Texas, Inc.

Location of most members subject to additional guides:

AZ, CA, CO, NV, OK, OR, TX, WA     

Location of plan information:

UnitedHealthcare West Supplement to this guide.

uhcprovider.com

Plan name:

UnitedHealthOne:

  • Golden Rule Insurance Company Group #705214

Location of most members subject to additional guides:

  • All markets

Plan name:

UnitedHealthOne:

  • Oxford Health Insurance, Inc. Group #908410

Location of most members subject to additional guides:

  • New Jersey

Location of plan information:

Plan name:

UnitedHealthcare Freedom Plans

Location of most members subject to additional guides:

NH, ME, VT

Location of plan information:

uhcprovider.com

Benefit plans not subject to this guide

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Plan name:

Rocky Mountain Health Plan (RMHP)   

Location of most members subject to additional guides:

CO

Additional guide/website

rmhp.org

Plan name:

Sierra:

  • Sierra Health and Life Insurance Co., Inc.
  • Sierra Healthcare Options, Inc.
  • Health Plan of Nevada, Inc.
  • Health Plan of Nevada Medicaid/Nevada Check Up

Location of most members subject to additional guides:

NV

Additional guide/website:

Benefit plans for Sierra Health and Life Insurance Company, Inc.:

sierrahealthandlife.com/provider

Benefit plans for Sierra Healthcare Options, Inc:

sierrahealthcareoptions.com

Benefit plans for Health Plan of Nevada, Inc.:

healthplanofnevada.com/provider

myhpnmedicaid.com/provider

Plan name:

UnitedHealthcare Community Plan Medicaid, CHIP and Uninsured

Location of most members subject to additional guides:

Multiple states

Additional guide/website:

UnitedHealthcare Community Plan Physician, Health Care Professional, Facility and Ancillary Administrative Guide for Medicaid, CHIP, or Uninsured.

 uhcprovider.com