2022 UnitedHealthcare Individual Exchange plans

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.

You can also find more information at UHCprovider.com/exchanges, including training and state-specific requirements.

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.

  • Referrals must be submitted electronically, unless otherwise allowed by law
  • To submit a referral request, use the Referrals tool on the Provider Portal

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:

  • Check prior authorization requirements
  • Submit a request
  • Check the status of an existing request

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.

You can find more information about site of service medical necessity reviews in our MRI/CT and surgical and office procedure FAQs.

Out-of-network coverage

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.

Questions?

Call Provider Services at 888-478-4760.

 

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