General resources for commercial and Individual Exchange plans

We have certain requirements for appointments, after-hours care and health care professional availability. For more information, please see these access and availability standard sections in our UnitedHealthcare Care Provider Administrative Guide:

• All commercial and Individual Exchange plans
• UnitedHealthcare Oxford plans
• UnitedHealthcare West

Care coordination among all health care professionals involved in a member’s care can help improve their health outcomes and overall experience.

For general care coordination resources, see the:

• Patient care coordination and case management section in our Administrative Guide
  • Includes information about our case management services, complex medical conditions programs and decision support programs
• Important Concepts in Integration: Coordination of Care page for helpful resources and tools

Point of Care Assist
One way to coordinate care is by using Point of Care Assist^®, a tool that provides you with real-time member information — including prior authorization, clinical, pharmacy, lab and cost data — in your existing electronic medical record.

Our coordination programs vary by plan. Some examples include:

Controlled substance monitoring
This program helps you identify members who may benefit from prescription pain management regimens. Through this program, you can receive a comprehensive member-specific report that includes the clinical issue of concern, prescription utilization details and recommended action(s).

Providers are encouraged to contact identified members to discuss and re-evaluate their overall pain management regimens and coordinate appropriate treatment, if indicated.

Timely postpartum care and maternity support
Timely postpartum care can help contribute to healthier outcomes for women after delivery. We use HEDIS^® guidelines to measure postpartum visit compliance. The standard is a postpartum visit between 7 and 84 days after delivery. Members can access maternity support resources on myuhc.com.

Kidney disease program
This program is designed to help improve clinical outcomes for members with end-stage renal disease (ESRD). The program coordinates care among the member’s care providers to help manage comorbid conditions as well as dialysis therapy. Goals include reducing inpatient hospitalizations, emergency room visits, transplant education and recommendations, and mortality — while improving quality of life.

Diabetic eye exam
Regular eye exam screenings for members with diabetes may help detect diabetic retinal disease. We use HEDIS guidelines to measure retinal eye exam performance for members ages 18–75 who have Type 1 or Type 2 diabetes. Continuity and coordination of care may be monitored through communication between the member’s primary care physician and the eye care professional performing the dilated retinal exam.

Transitions of care
Follow-up visits after a member is discharged from the hospital should be timely, especially for members with complex care and after-care needs who are at risk for relapse and rehospitalization. This includes members with behavioral health or substance use disorders.

Comprehensive and detailed medical records are key to helping promote quality medical care and improving patient safety. The Chapter 12: Medical records standards and requirements section in our Administrative Guide includes medical record guidelines, information about your access records and what we need you to document for each visit.

For medical record tools, templates and patient safety resources, visit our Patient Health and Safety page.

Help your patients get the care they need
If you have a patient who may benefit from case or disease management, please call the number on their member ID card to refer them to one of our programs. For more information, visit the Case management section in our Administrative Guide.

Our commercial and Individual Exchange plans serve a diverse group of individuals, and each state has membership with its own cultural and language needs. We’re here to support you in your efforts to communicate effectively with our members.

Example of languages by state

Resources
For more resources, including cultural competency training and language services, please visit our Cultural Competency page.

For information about how to receive language assistance and interpreter services, please call 877-542-9235.

Member rights and responsibilities can be found in the Administrative Guide.

*Indicates inverse measure where lower score represents better performance.

UnitedHealthcare Medicare Advantage plans

This data comes from the CAHPS survey and Centers for Medicare & Medicaid Services (CMS) Star Ratings. The percentages show how members rated UnitedHealthcare Medicare Advantage plans.

Please reference our Quick reference guide for out-of-network providers.