This directory includes care providers who serve our Commercial, Medicaid / Community Plan (excludes United Healthcare Community Plan of Rhode Island ) and Medicare members. information in the online or paper directories. PDF (Portable Document Format) files can be viewed with Adobe® Reader®. We do not make any representations regarding the quality of products or services offered, or the content or accuracy of the materials on such websites. We’re Your Partner to Connect with Members benefits and services, HEDIS® Measure: Appropriate Testing for Children with Pharyngitis, Community Plan Reimbursement Policies of Pennsylvania, Rhode Island AARP® Medicare Advantage Plans, Rhode Island Group Medicare Advantage Plans, Community Plan Reimbursement Policies of Rhode Island, South Carolina UnitedHealthcare Medicare Advantage Plans, South Dakota Group Medicare Advantage Plans, South Dakota AARP® Medicare Advantage Plans, TN UnitedHealthcare Medicare Advantage Plans, Fraud, Waste, and Abuse Update – Foot Baths and Prescription Anti-Infective Agents, Healthcare Professional Community Engagement Partnership, UnitedHealthcare Dual Complete – Medicare Advantage Special Needs Plan (DSNP) and UnitedHealthcare Community Plan – TennCare, Community Plan Reimbursement Policies of Tennessee, Tennessee Episodes of Care / Patient Centered Medical Home / TN Health Link / Medication Therapy Management, TX UnitedHealthcare® Chronic Complete Special Needs Plan, TX Erickson Advantage® Freedom/Signature Plans, Texas UnitedHealthcare Medicare Advantage Plans, TX UnitedHealthcare® MedicareDirect (PFFS), Making the Most of Life While Living With Complex Care Needs, Messages from the Texas Credentialing Alliance, Messages from the Texas Health and Human Services Commission, Community Plan Reimbursement Policies of Texas, Reference Guides and Value-Added Services, Utah UnitedHealthcare Medicare Advantage Plans, Utah UnitedHealthcare Medicare Advantage Assist plans, VT UnitedHealthcare® MedicareDirect (PFFS), Vermont UnitedHealthcare Medicare Advantage Plans, Virginia Erickson Advantage® Freedom/Signature Plans, Virginia UnitedHealthcare® MedicareDirect (PFFS), VA UnitedHealthcare Medicare Advantage Plans, Resources to Help You Prepare for a Challenging Influenza Season, Community & State Plan: 2020 Transportation Benefit Information, Initiation and Engagement of Alcohol and Other Drug Dependence Treatment, Medication Reconciliation Post-Discharge (MRP), UnitedHealthcare Dual Complete: Virginia Members Matched with a Navigator, Community Plan Reimbursement Policies of Virginia, Washington AARP® Medicare Advantage Plans, Washington Group Medicare Advantage Plans, UnitedHealthcare Dual Complete: Washington Members Matched With a Navigator, Pregnancy Intention Screening: Family Planning for Social Change, Community Plan Reimbursement Policies of Washington, West Virginia AARP® Medicare Advantage Plans, West Virginia Group Medicare Advantage Plans, Wisconsin UnitedHealthcare Medicare Advantage Plans, Wisconsin UnitedHealthcare Medicare Advantage Assist plans, Community Plan Reimbursement Policies of Wisconsin, Wyoming UnitedHealthcare® MedicareDirect (PFFS), U.S. Virgin Islands Commercial Health Plans, UnitedHealthcare Commercial Medical & Drug Policies and Coverage Determination Guidelines, UnitedHealthcare Commercial Reimbursement Policies, UnitedHealthcare West Benefit Interpretation Policies, UnitedHealthcare West Medical Management Guidelines, UnitedHealthcare Value & Balance Exchange Medical & Drug Policies and Coverage Determination Guidelines, Reimbursement Policies for UnitedHealthcare Value & Balance Exchange Plans, Medicare Advantage Reimbursement Policies, Community Plan Drug Lists for Limited Supplier Protocol, Community Plan Care Provider Manuals for Medicaid Plans By State, Welcome to UnitedHealthcare 2020 UnitedHealthcare Administrative Guide, Manuals and Benefit Plans Referenced in the Guide, Verifying Eligibility, Benefits and Your Network Participation, Network Participating Care Provider Responsibilities, Cooperation with Quality Improvement and Patient Safety Activities, Notification of Practice or Demographic Changes (Applies to Commercial Benefit Plans in California), Administrative Terminations for Inactivity, Coverage Summaries and Policy Guidelines for MA Members, Dual Special Needs Plans Managed by Optum, Free Medicare Education for Your Staff and Patients, Non-Participating Care Provider Referrals (All Commercial Plans), Medicare Advantage Referral Required Plans, Benefit Plans Not Subject to this Protocol, Advance Notification/Prior Authorization Requirements, Advance Notification/Prior Authorization List, Facilities: Standard Notification Requirements, How to Submit Advance or Admission Notifications/ Prior Authorizations, Updating Advance Notification or Prior Authorization Requests, Coverage and Utilization Management Decisions, Clinical Trials, Experimental or Investigational Services, Medical Management Denials/Adverse Determinations, Outpatient Cardiology Notification/Prior Authorization Protocol, Outpatient Radiology Notification/Prior Authorization Protocol, Specialty Pharmacy Requirements for Certain Specialty Medications (Commercial Plans - Not Applicable to UnitedHealthcare West) - Chapter 7, 2020 UnitedHealthcare Administrative Guide, Non-Emergent Ambulance Ground Transportation, Medicare Advantage Claim Processing Requirements, Pass-through Billing/CLIA Requirements/Reimbursement Policy, Special Reporting Requirements for Certain Claim Types, Claim Reconsideration, Appeals Process and Resolving Disputes, Medical Records Standards and Requirements, Commercial Health Services, Wellness and Behavioral Health Programs, Commercial and Medicare Advantage Behavioral Health Information, UnitedHealth Premium Designation Program (Commercial Plans), Star Ratings for MA and Prescription Drug Plans, Credentialing/Profile Reporting Requirements, Care Provider Rights Related to the Credentialing Process, Credentialing Committee Decision Making Process (Non-Delegated), Medicare Compliance Expectations and Training, Examples of Potentially Fraudulent, Wasteful, or Abusive Billing (not an inclusive list), Reporting Potential Fraud, Waste or Abuse to UnitedHealthcare, How to Contact All Savers, All Savers Supplement, How to Contact Us, Capitation and/or Delegation, Verifying Eligibility and Effective Dates, Capitation and/or Delegation, Commercial Eligibility, Enrollment, Transfers and Disenrollment, Capitation and/or Delegation, Medicare Advantage (MA) Enrollment, Eligibility and Transfers, and Disenrollment, Capitation and/or Delegation, Authorization Guarantee, Capitation and/or Delegation, Care Provider Responsibilities, Capitation and/or Delegation, Delegated Credentialing Program, Capitation and/or Delegation, Medical Management, Capitation and/or Delegation, Pharmacy, Capitation and/or Delegation Supplement, Facilities, Capitation and/or Delegation Supplement, Claims Processes, Capitation and/or Delegation Supplement, Claims Disputes and Appeals, Capitation and/or Delegation Supplement, Capitation Reports and Payments, Capitation and/or Delegation Supplement, Contractual and Financial Responsibilities, Capitation and/or Delegation Supplement, CMS Premiums and Adjustments, Capitation and/or Delegation Supplement, Delegate Performance Management Program, Capitation and/or Delegation Supplement, Appeals and Grievances, Capitation and/or Delegation Supplement, Confidentiality of Protected Health Information (PHI), Member Rights and Responsibilities, Medica, Documentation and Confidentiality of Medical Records, Provider Reporting Responsibilities, Medica, Discharge of a Member from Participating Provider's Care, Quality Management and Health Management Programs, Care Provider Responsibilities and Standards, Oxford, Using Non-Participating Health Care Providers or Facilities, Oxford, Radiology, Cardiology and Radiation Therapy Procedures, Claims Recovery, Appeals, Disputes and Grievances, Case Management and Disease Management Programs, Medical and Administrative Policy Updates, Oxford, Confidentiality of Protected Health Information (PHI), Preferred Care Partners, Prior Authorizations and Referrals, Preferred Care Partners, Clinical Coverage Review, Preferred Care Partners, Appeal & Reconsideration Processes, Preferred Care Partners, Documentation and Confidentiality of Medical Records, Preferred Care Partners, Case Management and Disease Management Program Information, Preferred Care Partners, Special Needs Plans, Preferred Care Partners, Care Provider Reporting Responsibilities, Preferred Care Partners, UnitedHealthcare West Information Regarding our Care Provider Website, How to Contact UnitedHealthcare West Resources, Care Provider Responsibilities, UnitedHealthcare West, Utilization and Medical Management, UnitedHealthcare West, Hospital Notifications, UnitedHealthcare West, Care Provider Claims Appeals and Disputes, UnitedHealthcare West, California Language Assistance Program (California Commercial Plans), UnitedHealthcare West, Member Complaints & Grievances, UnitedHealthcare West, California Quality Improvement Committee, UnitedHealthcare West, Member Complaints & Grievances, UnitedHealthOne, Home Health and SNF High-Performing Provider Initiative Lists, Quality-Based Physician Incentive Program (QPIP), UnitedHealthcare Capitation, Claim, Quality, Roster and Profile Reports, UnitedHealthcare West Capitation, Settlement, Shared Risk Claims, Eligibility, and Patient Management Reports, United Healthcare Community Plan of Rhode Island, Search for Care Providers in the General UnitedHealthcare Plan Directory, View More Demographic Information Update Resources, Search the NexusACO Care Provider Directory, Optum Behavioral Health, EAP, Worklife & Mental Health Services, Optum's Complex Medical Centers of Excellence Provider Network, Search for a pharmacy in the OptumRx network, Relative Cost of Network Providers Referral Tool, Access the UnitedHealthcare General Provider Directory, Learn more about Relative Cost of Network Providers, UnitedHealthcare of California Ancillary Care Provider Referral Directory, Select the UnitedHealthcare of California Ancillary Care Provider Referral Directory of Your Choice, UnitedHealthcare West (SignatureValue) Commercial Physician Directory, Around The Clock Home Health Care Termination – Effective Dec. 16, 2019, Deere Premier Network Providers (Use ONLY for John Deere Group Number 709335), UnitedHealthcare Retiree Medicare Physician Directory.
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