Policies and Protocols
This library includes UnitedHealthcare policies and protocols. The policies and protocols presented here may not apply to all UnitedHealthcare plans.
View the current policies that apply to UnitedHealthcare Commercial benefit plans.
Medicare Advantage Policies
View the current policies that apply to UnitedHealthcare and Affiliated Medicare Advantage benefit plans.
Community Plan Policies
View the current policies that apply to the UnitedHealthcare Community Plan benefit plans.
- Clinical Guidelines
- Dental Clinical Policies and Coverage Guidelines
- Requirements for Out-of-Network Laboratory Referral Requests
- Laboratory Test Registry
- UnitedHealthcare Credentialing Plan 2019–2021
- Credentialing Plan State and Federal Regulatory Addendum: Additional State and Federal Credentialing Requirements
Hospital Outpatient Facility Reimbursement Policies
- Hospital Outpatient Radiology Services Rebundling Reimbursement Policy - Commercial and UnitedHealthcare Community Plan: This policy describes the rebundling edits applied by UnitedHealthcare to determine reimbursement for the technical component of hospital outpatient radiology services contracted under the UnitedHealthcare Facility Outpatient Radiology Fee Schedule.
- Hospital Outpatient Laboratory and Pathology Services Rebundling Reimbursement Policy - Commercial and UnitedHealthcare Community Plan: This policy describes reimbursement for hospital outpatient laboratory and pathology services reimbursed according to the UnitedHealthcare Facility Laboratory and Pathology Fee Schedule.