Policies and Clinical Guidelines

Reimbursement Policies

For reimbursement guidance for Community Plan members, view the current UnitedHealthcare Community Plan Reimbursement Policies. 

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We have compiled a list of evidence-based clinical guidelines and where they can be found for our quality and health management programs. 

We respect the expertise of the physicians and other health care professionals in our network and appreciate your help as we work together to offer our members better quality, better health outcomes and better cost.

If you have questions, please contact your Physician Advocate or call the number on the back of the member’s ID card.

UnitedHealthcare has developed Medical Policies, Medical Benefit Drug Policies and Coverage Determination Guidelines to assist us in administering health benefits. These policies and guidelines are provided for informational purposes, and do not constitute medical advice.

For policy guidance for Medicare Advantage plan members, view the UnitedHealthcare Medicare Advantage Coverage Summaries and corresponding Policy Update Bulletins.

Healthcare Effectiveness Data and Information Set (HEDIS) is a standardized set of performance measurements developed by the National Committee for Quality Assurance (NCQA) to evaluate consumer health care.