Understanding your network participation - Chapter 4, 2022 UnitedHealthcare Administrative Guide

You may already participate in benefit plans offered on the Individual Exchange if you participate in UnitedHealthcare’s commercial benefit plans, unless the network is listed as an excluded benefit plan in your Agreement. For Individual Exchange Benefit Plan and Charter Exchange networks, you must also have a location in the network service area to be eligible for in network coverage.

As a participating health care provider, you agree to give UnitedHealthcare members equal access to the treatment they need. This includes service or treatment for any Exchange member with plans in which you participate.

Reimbursement

Reimbursement for Individual Exchange plans is the same as your commercial rates, unless your Agreement includes a specific Payment Appendix for the network name (Individual Exchange Benefit Plan, Charter).

Health plan ID card

This sample ID card is for illustration only. Actual information varies depending on payer, plan and other requirements.

1. Name of the state Exchange
2. Payer ID used for electronic data interchange
3. PCP information or “PCP Required” reference
4. Referral required indicator (if applicable)
5. Member’s network name
6. Referral requirement statement (if applicable)
7. Claims mailing address