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Policies and Clinical Guidelines

Reimbursement Policies

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

Behavioral Policy & Analytics Committee Approval - January 20, 2015
Kansas Provider Advisory Committee Approval - June 17, 2015

View the Behavioral Health Guidelines and Changes.

We’ve put together this list of evidence-based clinical guidelines, and the websites where they can be found, for our quality and health management programs. We hope you find this information helpful as we work together to offer our members, your patients, 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. 

HEDIS 2017 involves the acquisition, abstraction and validation of member records for the calendar year 2016.

KanCare HEDIS Frequently Asked Questions