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Clinical Practice Guidelines 


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

1) State Medical Policies
2) UnitedHealthcare Medical Policies
3) Milliman Care Guidelines

UnitedHealthcare has developed Medical Policies, Drug Policies, and Coverage Determination Guidelines to assist us in administering health benefits. These policies and guidelines are provided for informational purposes, and do not constitute medical advice.

View state medical policies below.
UnitedHealthcare Medical Policies are viewable here.
Medicare Medical Policies are viewable here.


Clinical Practice Guidelines

UnitedHealthcare Community Plan has compiled a list of evidence-based clinical guidelines, and the websites where they can be found, for our quality and health management programs.

We respect the expertise of the physicians and other health care professionals in our network and appreciate your help as we work together to offer our members better quality, better health outcomes and better cost.

If you have questions, please contact your Physician Advocate or call the number on the back of the member’s ID card.

View the Clinical Practice Guidelines (PDF 134.51 KB). 

Provider Advisory Committee Approval - July 27, 2017