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Resources and tools for providers and health care professionals

We invite you to use this website, created especially for health care professionals, to find resources that can help you as you care for your patients. Here you can find our medical policies, stay up to date on the latest news or get training on our many tools and benefit plans.

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News

New ORP claim edits for UnitedHealthcare Community Plan of Ohio

New ORP claim edits start April 1, 2025. Include NPI to avoid Y42 denials.

UnitedHealthcare Outpatient Procedure Grouper Exhibit annual reimbursement update

Review the 2025 Outpatient Procedure Grouper (OPG) Exhibit for annual changes to reimbursement.

Rhode Island Medicaid: OAE testing is not medically necessary for routine hearing screening

Use otoacoustic emissions (OAE) testing only for infants, children under age 4 and some adult populations. Learn why.

Ensure PCP assignment to avoid reimbursement denial

UHCCP members must visit a PCP in the same practice (same Tax ID) as the PCP listed on their ID card.

Texas Medicaid: State-required medication prior authorization updates

Effective May 1, 2025, we’re updating Texas Medicaid clinical prior authorization criteria for certain medications.