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2018
Administrative Guide/
Provider Manual
Physician, Health Care Professional, Facility
and Ancillary Provider
UnitedHealthcare Connected TM (Medicare Medicaid Plan)
Serving the following Service
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What is an ancillary provider?
An ancillary provider is a third-party entity that provides support services to a primary service provider.
Who is required to file an ancillary provider?
The primary service provider is required to file an ancillary provider.
How to fill out an ancillary provider?
You can fill out an ancillary provider by providing the required information about the third-party support services being provided.
What is the purpose of an ancillary provider?
The purpose of an ancillary provider is to document and track the support services being provided by third-party entities.
What information must be reported on an ancillary provider?
Information such as the name of the ancillary provider, services provided, and contact information must be reported on an ancillary provider.
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