Important information for Georgia commercial plan health care providers

Review advance notice requirements for out-of-network providers and balance billing for non-covered service protocols impacting Georgia commercial plan members.

Out-of-network referrals

• You must refer members to other network providers except in emergency situations. 
• If an out-of-network referral or prior authorization is necessary, refer to the Nonparticipating health care providers (all commercial plans) section of the administrative guide. 

Non-covered services and balanced billing

• Before providing a non-covered service, confirm member consent using the Member Advance Notice form 
• This protects members from unexpected charges and helps ensure compliance

New weight-loss medication authorization requirement — Effective Feb. 1, 2026

• For Georgia State Health Benefit Plan (SHBP) members enrolled in a UnitedHealthcare HMO or high-deductible health plan (HDHP) plan, only 9amHealth care providers may prescribe weight loss medications. This doesn’t apply to diabetic GLP-1s, like Ozempic and Mounjaro.
• We will not accept prior authorizations or prescriptions from any other health care providers
• SHBP members with an active weight-loss medication prior authorization will receive instruction to enroll in 9amHealth when the authorization expires  
• Please direct members who need these medications to enroll at join9am.com/shbp or call 888-870-9542.

NOTE: SHBP has notified affected members about the new requirement and asked them to enroll with 9amHealth at join9am.com/shbp. Please remind members of this change as needed to help ensure their treatment continues without interruption.

Quick links

• Care Provider Administrative Guide to learn more about specific protocols 
• 2026 State Health Benefit Plan benefits grid 
• UnitedHealthcare Provider Portal to view health plan benefits and details

Questions? We’re here to help.

Connect with us through chat 24/7 in the UnitedHealthcare Provider Portal or contact provider services for the Georgia State Health Benefit Plan at 866-804-3867.