Interoperability protocol - Chapter 9, 2022 UnitedHealthcare Administrative Guide

To help encourage the exchange of real-time health information, you are required to communicate with us electronically through the use of near real-time data exchange services, based on Health Level Seven (HL7) standards inside your Electronic Health Record (EHR) workflow. This includes services, such as:

  • Eligibility inquiries: HL7 Fast Healthcare Interoperability Resources (FHIR).
  • Patient care opportunities.
  • Admission, discharge and transfer (ADT) notifications: HL7 ADT.
  • High-performing provider referral with cost estimation.
  • Identification of preferred labs and/or diagnostic radiology locations.
  • Prior authorization for medical and pharmacy services.

As a result of this protocol, we are expanding our medical records standards and requirements. If asked, you’ll work with us to develop a clinical data exchange and integration plan within 60 days of outreach to provide us with remote access to your EHR for UnitedHealthcare members. This clinical data exchange and integration plan will support near real-time data exchanges with UnitedHealthcare in an automated fashion. To support this initiative, we’ll work with you to establish EHR access to decrease the administrative burden for programs that aren’t currently supported by interoperability standards. These capabilities are in addition to the requirements of the medical record in your Participation Agreement. If we can’t access the medical records in your EHR system, or the information contained in your EHR system is unclear or insufficient, you’ll need to submit paper copies of medical records for UnitedHealthcare members upon request.

For more information, go to > Policies and Protocols > under Additional Resources > Protocols.