The updated 2023 UnitedHealthcare Care Provider Administrative Guide for commercial and Medicare Advantage plans will be available at UHCprovider.com/guides. For care providers newly contracted on or after Jan. 1, 2023, the new guide is effective Jan. 1, 2023. For currently contracted physicians, health care professionals, facilities and ancillary health care providers, the new guide is effective April 1, 2023.
We post this essential resource for physicians, hospitals, facilities and other health care providers annually.
The list of topics below are new for 2023. This list is not exhaustive, so refer to the 2023 UnitedHealthcare Provider Administrative Guide for commercial and Medicare Advantage for specific information.
|All references to Bind changed to Surest|
|Kansas, Mississippi, Missouri and Ohio will offer Individual Exchange plans, also referred to as UnitedHealthcare Individual & Family ACA Marketplace plans||Chapter 4|
|Government inspections and audits||Chapter 4|
|Protocols for UnitedHealthcare CSNP members managed by Optum||Chapter 5|
|Medicare Part D vaccines||Chapter 8|
|Transact Rx||Chapter 8|
|Kidney resource services||Chapter 13|
|Member communication scope
Delegate fraud, waste and abuse
Special Needs Plan (SNP) Model of Care (MOC)
Non UnitedHealthcare West (Medicare Advantage only)
Facility and regulatory surcharge
|Capitation and/or delegation supplement|
|Oxford Level Funded Plans (NJ and CT) Name Changed to Oxford Level Funded Plans (Connecticut, New Jersey, and New York)||Oxford Level Funded Plans (Connecticut, New Jersey, and New York)|
New health plan supplements:
If you have questions, contact us.