On Jan. 1, 2022, we plan to launch Individual Exchange benefit plans, also referred to as Individual and Family plans, in 7 new states, including Alabama, Florida, Georgia, Illinois, Louisiana, Michigan and Texas.
We’ll continue to offer Individual Exchange plans in existing states: Arizona, Maryland, North Carolina, Oklahoma, Tennessee, Virginia and Washington.
We want to share important information with you about these plans to help you prepare to care for Exchange members in 2022.
PCPs must submit a referral request
In all states except Alabama, Louisiana and North Carolina, Individual Exchange plans require a referral from a network primary care provider (PCP) for a member to see a specialist.
Prior authorization requirements
Prior authorization requests for Exchange plan members must be submitted electronically, unless otherwise allowed by law.
New to the Prior Authorization and Notification tool?
The Prior Authorization and Notification tool on the Provider Portal enables you to:
Site of service medical necessity reviews
For all states except Texas, we’ll conduct site of service medical necessity reviews for any procedures/codes referenced in the UnitedHealthcare site of service utilization review guidelines.
Exchange plans have no out-of-network coverage for non-emergent services. To locate an in-network provider or lab, visit UHCprovider.com/findprovider and search the directories for state exchanges.
Call Provider Services at 888-478-4760.