Updates to Individual Exchange plans for 2023

New states, plan details and a self-paced interactive guide

On Jan. 1, 2023, we’re launching UnitedHealthcare Individual Exchange plans, also referred to as Individual and Family plans, in 4 new states. We’ll continue to offer these plans in the 14 existing states where we currently offer them.

Prepare for the new plans

To help ensure your practice is ready to see Individual Exchange plan members in 2023, visit UHCprovider.com/exchanges to learn more about the plans and access:

• State-specific information
• The new 2023 Individual Exchange plans self-paced interactive guide
• Policies, coverage determination guidelines and prior authorization/notification and referral requirements

Please also prepare by:

• Verifying your network participation by signing into the UnitedHealthcare Provider Portal at UHCprovider.com/portal
• Sharing information with your staff about your participation and the requirements for referrals and prior authorization/notifications
  • In most states,* these plans require a referral from an in-network primary care provider (PCP) for a member to see a specialist**
• Modifying your business processes to recognize referral-required plans, if applicable
• Noting that members must select a PCP to help coordinate their care, or we’ll assign them a PCP after 30 days
  • Physicians may also submit PCP change requests for members
• Confirming that your staff have access to submit referrals and check referral statuses
• Noting that we’ll conduct site of service medical necessity reviews for any procedures/codes in our UnitedHealthcare Individual Exchange Medical & Drug Policies and Coverage Determination Guidelines***
• Verifying and updating your demographic information using the My Practice Profile tool at UHCprovider.com/mpp

Questions?

Visit UHCprovider.com/exchanges or contact your provider advocate.

*Except for Alabama, Kansas, Louisiana, Missouri, Mississippi, North Carolina, Oklahoma and Tennessee

**In Maryland and Virginia, we’ll offer some plans that require referrals and other plans that don’t require referrals.

***Except for Texas

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