Important Exchange Plan Resources

Starting Jan. 1, 2021, Exchange plans will be available in Arizona, Maryland, North CarolinaOklahoma, Tennessee, Virginia and Washington.


The protocols listed below are now available on and include Exchange plan business information.

  1. Medical Record Requirements for Pre-Service Reviews
  2. Participating Provider Laboratory and Pathology Protocol
  3. Participating Provider Laboratory and Pathology Protocol — FAQS

Site of Service Medical Necessity Reviews

Certain out-patient surgical procedures and office based procedures will require site of service medical necessity reviews.

Reimbursement Policies

Exchange plan reimbursement policies are now available at Please take the time to review before Jan. 1, 2021.

Effective Jan. 1, 2021, the UnitedHealthcare Telehealth and Telemedicine Reimbursement policy will apply to Exchange plans. You can find more information on the Telehealth and Telemedicine Reimbursement Policy at > Reimbursement Policy > Commercial.

Questions? Please contact 888-478-4760.