New 2024 Individual Exchange plans and prior authorization information

On Jan. 1, 2024, we’ll launch UnitedHealthcare Individual Exchange plans¹ in 4 new states. We'll also continue to offer these plans in the 22 states where they currently exist. 

New states for 2024

• New Jersey (Oxford Metro network)
• New Mexico (Choice network)
• South Carolina (Individual Exchange network)
• Wisconsin (Individual Exchange network)

Prior authorization information

Visit a list of prior authorization codes for the new states.

Prepare for the new plans

To help ensure your practice is ready to see Individual Exchange plan members in 2024, visit UHCprovider.com/exchanges where you can learn more about the plans and access:

• Coverage determination guidelines
• Medical and reimbursement policies
• Pharmacy information
• Prior authorization/notification and referral requirements
• State-specific plan information
• The new 2024 Individual Exchange plans self-paced interactive guide

Please also prepare by:

• Sharing information with your staff about your participation and referral requirements
  • In most states,² these plans require a referral from an in-network primary care provider (PCP) for a member to see a specialist³
  • Members must select a PCP to help coordinate their care, or we’ll assign them a PCP after 30 days
• Modifying your business processes to recognize referral-required plans, if applicable
• Confirming that your staff have access to submit referrals and check referral statuses, if applicable
• Reviewing the prior authorization list at Advance Notification and Clinical Submission Requirements
• Reviewing our UnitedHealthcare Individual Exchange Medical & Drug Policies and Coverage Determination Guidelines and noting that we’ll conduct site of service medical necessity reviews for all procedures/codes⁴

Questions?

If you have questions, visit UHCprovider.com/exchanges, contact your provider advocate or chat with a live advocate 7 a.m.–7 p.m. CT from the UnitedHealthcare Provider Portal Contact Us page

¹Also referred to as UnitedHealthcare Individual & Family ACA Marketplace plans
²Except Alabama, Kansas, Louisiana, Missouri, Mississippi, New Jersey, New Mexico, North Carolina, Oklahoma, South Carolina and Tennessee.
³In Maryland and Virginia, we’ll offer some plans that require referrals and other plans that don't require referrals.
⁴Except for Texas

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