Policies and Clinical Guidelines

Utilization Management (UM) Program

State Clinical Coverage Policies

Reimbursement Policies

View the current UnitedHealthcare Community Plan Reimbursement Policies

Clinical Guidelines

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 Community Plan Medical Policies

We have developed Medical Policies to assist us in administering health benefits. These policies and guidelines are provided for informational purposes and do not constitute medical advice.

Optum Behavioral Health Guidelines