Payer policies
UnitedHealthcare medical and reimbursement policies
UnitedHealthcare publishes its provider policies on uhcprovider.com, split by line of business: commercial, Medicare Advantage, Community Plan (Medicaid) and Individual Exchange. Each line of business has its own medical and drug policy library and its own reimbursement policy library, so the policy that applies depends on the member's plan, not just the service.
Community Plan adds a state layer. The multi-state Community Plan library excludes 12 states (ID, IN, KS, KY, LA, NE, NJ, NM, NC, OH, PA and TN), which publish their own state pages.
Where UnitedHealthcare publishes its policies
Official UnitedHealthcare pages, checked Oct 25, 2026. Policies change often; always read the version on the payer's site for your date of service.
Policies and Protocols for Providers
The hub for every UnitedHealthcare policy library, by line of business.
Medical policyCommercial medical and drug policies
Medical policies and medical benefit drug policies for commercial plans, with monthly update bulletins.
ReimbursementCommercial reimbursement policies
Coding, modifier and billing rules for commercial claims, with update bulletins.
Medicare AdvantageMedicare Advantage medical policies
Medical and drug policies for Medicare Advantage plans, with monthly update bulletins.
Medicare AdvantageMedicare Advantage reimbursement policies
Reimbursement policies for Medicare Advantage claims, with monthly update bulletins.
MedicaidCommunity Plan medical and drug policies
The multi-state Community Plan library, with links out to the states that publish separately.
MedicaidCommunity Plan reimbursement policies
Reimbursement policies for Community Plan claims.
Prior authorizationPrior authorization and notification
Advance notification and prior authorization requirement documents by plan type.
Drug policyDrug lists and pharmacy
Formularies and pharmacy clinical programs across lines of business.
UnitedHealthcare in RCIntel
RCIntel's policy library includes UnitedHealthcare's posted medical, drug and reimbursement policies for commercial, Medicare Advantage, Community Plan and Individual Exchange plans, plus the separate state Community Plan libraries. You can query them over the API and MCP, or upload a specific policy to Payer Intelligence.
Ask a UnitedHealthcare policy a question
Upload a UnitedHealthcare policy to Payer Intelligence and ask it what you need to know. Every answer cites the section and page it came from.
Common questions
How often does UnitedHealthcare update its medical policies?
UnitedHealthcare's commercial, Medicare Advantage and Community Plan medical policy pages each say a new update bulletin is published on the first calendar day of every month.
Which UnitedHealthcare policy applies to my claim?
The one for the member's line of business. A commercial medical policy and a Medicare Advantage policy on the same service can differ, and Community Plan members in some states fall under a state-specific library.
What is the difference between a medical policy and a reimbursement policy?
A medical policy says when a service is covered or medically necessary. A reimbursement policy says how a covered service is paid: coding, modifiers, bundling and billing rules.