Policies and clinical guidelines
Review these payment policy updates to help code and submit your claims correctly. To receive email notifications of payment policy updates, please sign up for Network News.
We have compiled a list of evidence-based clinical guidelines and where to find them for our quality and health management programs.
We respect the expertise of the physicians and other health care professionals in our network. We appreciate your help as we work together to offer our members better quality and health outcomes at better costs.
If you have questions, please contact your physician advocate or call the number on the back of the member's ID card.
UnitedHealthcare has developed Pharmacy Clinical Determination Guidelines to help us manage health benefits. These policies and guidelines are for informational purposes only and do not serve as medical advice.
You can find reimbursement guidance for Community Plan members by checking the current reimbursement policies.
UnitedHealthcare has developed medical policies, medical benefit policies and coverage determination guidelines to help us manage health benefits. These policies and guidelines are for informational purposes only and do not serve as medical advice.
Need help?
Connect with us through chat 24/7 in the UnitedHealthcare Provider Portal, or contact our call center at 800-445-1638, available 8 a.m.–5 p.m. CT.