See what’s new: Georgia 2025 provider protocols

Please remember to review the following provider protocols for Georgia commercial plan members for 2025. These impact advance notice requirements for out-of-network providers and balance billing for non-covered services.

Advance notice to members involving out-of-network providers

This protocol states that network physicians and health care professionals are required to refer members to other network providers except in emergency situations.

• In the event an out-of-network referral/notification or prior authorization is required, please obtain written acknowledgement from the member confirming:
  • The out-of-network provider is not in the UnitedHealthcare network
  • The member is aware that network providers are available
  • The member understands they may be subject to balance billing by the out-of-network provider
• If the member agrees to receive care from an out-of-network provider, after discussing network provider options, physicians and other health care professionals must keep the signed Member Advance Notice Form on file and provide it to UnitedHealthcare upon request or during an audit)

Balance billing for non-covered services

Under this protocol, which applies to both commercial HMO and HDHP plans, network providers must protect members from any charges that may result from denied benefits due to non-covered service determinations.

The only exception is if the network provider has written authorization from the member acknowledging that the service to be provided is not covered, and they agree to pay for it out of pocket.

Learn more

Learn more about the specific protocols in our Care Provider Administrative Guide.

2025 State Health Benefit Plan (SHBP) Commercial Benefit Plan updates

Log into the UnitedHealthcare Provider Portal to view the updated benefit plan and complete benefit details for SHBP commercial members, or check out the 2025 State Health Benefit Plan benefits at a glance.