UnitedHealthcare West supplement - 2022 UnitedHealthcare Administrative Guide

Applicability of this supplement

This supplement is intended for use by non-capitated physicians, health care professionals, facilities, ancillary health care providers and their respective staff. Unless otherwise specified, any references to UnitedHealthcare West in this supplement are intended to apply to any or all of the entities and benefit plans listed below. This information is subject to change.

Capitation is a payment arrangement for health care providers. If you have a capitation Agreement with us, you are paid a set amount for each member assigned to you, whether or not that person seeks care. If you have a UnitedHealthcare Westcapitation Agreement with us, refer to the Capitation and/or Delegation Supplement of the guide as this supplement does not apply to you.

Health care providers who participate in the listed benefit plans are subject to both the main guide and this supplement. This supplement controls if it conflicts with information in the main guide. If there are additional protocols, policies or procedures online, you will be directed to that location when applicable. For protocols, policies and procedures not referenced in this supplement, refer to appropriate chapter in the main guide.

You may identify a UnitedHealthcare West member by a reference to “WEST” on the back of their ID card. Information may vary in appearance or location on the card due to unique benefit plan requirements.

You may see more detailed information on ID cards and a sample health plan ID card, in the section titled Commercial Health Care ID Card Legend in Chapter 2: Provider responsibilities and standards. You may see a sample ID card image specific to the member when you verify eligibility and benefits in the UnitedHealthcare Provider Portal.

Benefit plans referenced in this supplement

We offer a wide range of products and services for employer groups, families and individual members. Benefit plan availability may vary. Contact us for more information about benefit plan availability and service areas where each of these products and supplemental benefits are available.

Commercial products

Commercial benefit plans consist of Health Maintenance Organizations (HMOs) or Managed Care Organizations (MCOs). Members access health services through a network primary care physician (PCP). PCPs manage the member’s medical history and individual needs. HMOs/MCOs offer minimal paperwork and low, predictable out-of-pocket costs. Members pay a predetermined copayment or a percentage copayment each time they receive health care services.

MA products

Refer to Chapter 5: Medicare products for a description of Medical Advantage (MA) products offered. You may see a complete list of health plans on uhcprovider.com/plans.

Administrative services are provided by the following affiliated companies: UnitedHealthcare Services, Inc. OptumRx or OptumHealth Care Solutions, LLC.

Behavioral health products are provided by U.S. Behavioral Health Plan. California is doing business as OptumHealth Behavioral Solutions of California or United Behavioral Health operating under the brand Optum.

MA Special Needs Plans (SNP)

SNPs are part of the MA program. These plans are designed for members with unique health care needs. They offer benefits in addition to those covered under Original Medicare (including Part D prescription drug coverage) and intended to keep the member healthy and as independent as possible. UnitedHealthcare offers 2 types of MA SNPs within the plans covered by this supplement in select states: Chronic SNPs and Dual SNPs.