Information regarding the use of this supplement, River Valley - 2022 UnitedHealthcare Administrative Guide

This supplement applies to covered services rendered to River Valley entities members. This supplement does not apply to Medicare Advantage, Medicaid or CHIP benefit plans.

It also applies to health care providers who have the following:

1. A UnitedHealthcare Agreement with one of the following:
   • A reference to the River Valley or John Deere Health protocols or guides
   • A direct contract with 1 or more River Valley entities that participate in River Valley entities networks
2. Located in Arkansas, Georgia, Iowa, Tennessee, Virginia, Wisconsin or the following Illinois counties: Jo Daviess, Stephenson, Carroll, Ogle, Whiteside, Lee, Mercer, Rock Island, Henry, Bureau, Putnam, Henderson, Warren Knox, Stark, Marshall, Livingston, Hancock, McDonough, Fulton, Peoria, Tazewell, Woodford, McLean.

The following River Valley entities sponsor, issue and administer River Valley benefit plans:

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

The River Valley entity is listed on the front of the member’s ID card (bottom left).

Health care providers who are not subject to this supplement (including health care providers in Louisiana, North Carolina, Ohio and South Carolina) may disregard this information. You may work with us when providing services to River Valley members in the same way as you do when providing services to other UnitedHealthcare members.

For protocols, policies and procedures not specified in this supplement, refer to appropriate chapter in the main guide.

For policies and procedures relating to the TennCare®, Iowa Medicaid/hawk-i®, and Secure Plus Complete Medicaid Plans®, refer to the UnitedHealthcare Community Plan administrative guides available on uhcprovider.com/guides.