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Medical policies

The Medical Policies and corresponding update bulletins for UnitedHealthcare Community Plan of North Carolina are listed below.

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A monthly notice of recently approved and/or revised Medical Policies is provided below for your review. We publish a new announcement on the first calendar day of every month.

The appearance of a health service (e.g., test, drug, device, or procedure) in the Medical Policy Update Bulletin does not imply that UnitedHealthcare provides coverage for the health service. In the event of an inconsistency or conflict between the information provided in the Medical Policy Update Bulletin and the posted policy, the provisions of the posted policy will prevail.

Current Policies

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Community Plan of North Carolina Medical Policies Terms and Conditions

Please read the terms and conditions below carefully.

UnitedHealthcare has developed Medical Policies to assist us in administering health benefits. These policies are provided for informational purposes and do not constitute medical advice. Treating physicians and health care providers are solely responsible for determining what care to provide to their patients. Members should always consult their physician before making any decisions about medical care.

Our Medical Policies express our determination of whether a health service (e.g., test, device, or procedure) is proven to be effective based on the published clinical evidence. They are also used to decide whether a given health service is medically necessary. Services determined to be experimental, investigational, unproven, or not medically necessary by the clinical evidence are typically not covered.

Benefit coverage for health services is determined by the specific benefit plan. When deciding coverage, the federal, state, or contractual requirements for benefit plan coverage must be referenced. In the event of a conflict, the federal, state, or contractual requirements for benefit plan coverage supersede these policies.

Medical Policies are developed as needed, regularly reviewed and updated, and subject to change. They represent a portion of the resources used to support UnitedHealthcare coverage decision making. The information presented in these policies is believed to be accurate and current as of the date of publication and is provided on an "AS IS" basis. Additionally, UnitedHealthcare may use tools developed by third parties, such as the InterQual® criteria, to assist us in administering health benefits. UnitedHealthcare Medical Policies are intended to be used in connection with the independent professional medical judgment of a qualified health care provider and do not constitute the practice of medicine or medical advice.

Medical Policies are the property of UnitedHealthcare. Unauthorized copying, use, and distribution of this information are strictly prohibited. The InterQual® criteria are proprietary to Change Healthcare and are not published on this website.

When these policies are used to determine medical necessity, clinical guidelines will be applied in the following order:

  1. State/Federal Guidelines and Contract Requirements
  2. UnitedHealthcare Community Plan of North Carolina Medical Policies
  3. InterQual® criteria

By clicking "I Agree," you agree to the terms and conditions expressed herein, in addition to our Site Use Agreement.

 

 

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