UnitedHealthcare Exchange plans have some unique requirements for care providers. With these plans now available in 11 states, we want to some tips to help you avoid claim denials and make it easier to work with us as you care for Exchange plan members.
Determining your network status
Care providers participating in UnitedHealthcare commercial plans also participate in Exchange plans, unless the network is listed as an excluded plan in your Participation Agreement
Participating providers must have a location in the network service area to be eligible for in-network coverage. Exchange plans do not have out-of-network benefits.
Referrals are required for members to see a network specialist, with some exceptions. To see which services do not require a referral, see the UnitedHealthcare Exchange plan FAQs
Specialists must be in-networkandlocated within the defined service area for the member to have coverage. You can view the service area for each state at UHCprovider.com/exchanges.
Unless required by state law, referrals must be submitted electronically or the claim will be denied