CurrentColorado Rocky Mountain Health PlansPolicy ADMINISTRATIVE 300.1

Adoption of UnitedHealthcare Commercial Medical Policies for Oxford Commercial Plans

Governs use of UnitedHealthcare Commercial Medical Policies for Oxford Commercial plan membership and describes access and applicability; affects Oxford Commercial plan members and Oxford policy administrators.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyAdoption of UnitedHealthcare Commercial Medical Policies for Oxford Commercial Plans

Policy CodePolicy ADMINISTRATIVE 300.1

Change TypeNew administrative policy

Effective DateJanuary 1, 2026

Next Review Date

Key ActionProviders should follow UnitedHealthcare Commercial Medical Policies for clinical coverage decisions for Oxford Commercial members and verify member contract or Certificate of Coverage for benefits and exclusions.

SourceLink

POLICY UPDATE CHANGES

New Administrative Policy effective January 1, 2026.

Jan 1, 2026Effective date

Oxford CommercialApplicable lines of business

NoneRelated policies listed

1TOC reference pages

Adoption and Applicability

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyAdoption of UnitedHealthcare Commercial Medical Policies for Oxford Commercial Plans

Policy CodePolicy ADMINISTRATIVE 300.1

Change TypeNew administrative policy

Effective DateJanuary 1, 2026

Next Review Date

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Adoption and applicability

Coverage determinations and applicability:

ALL of the following

UnitedHealthcare Commercial Medical Policies will be used for Oxford Commercial plan membership clinical policies.
Oxford will no longer maintain duplicate Oxford-specific Medical (Clinical) Policy versions; Oxford Administrative Policies will retain the same external access as before January 1, 2026.
Services described in adopted policies remain subject to the terms, conditions, limitations, exclusions, and benefit language in the member's contract or Certificate of Coverage, which govern if differences exist.
Certain policies may not apply to Self-Funded members and certain insured products; confirm applicability with the member-specific benefit plan document or Certificate of Coverage.

Oxford reserves the right to modify policies as necessary without prior written notice unless otherwise required by Oxford's administrative procedures or applicable state law.

Provider Responsibilities and Reference Policy

Documentation Required

Follow UHC Commercial Medical Policies and verify member benefits

Follow UnitedHealthcare (UHC) Commercial Medical Policies for clinical coverage decisions for Oxford Commercial members; verify the member’s contract or Certificate of Coverage for benefits, exclusions, limitations, and applicability.

Effective January 1, 2026, Oxford will utilize the UnitedHealthcare Commercial Medical Policies and will no longer maintain duplicate Oxford-specific clinical policy versions. [[source]]
Services described in adopted policies remain subject to the terms, conditions, limitations, exclusions, and benefit language in the member’s contract or Certificate of Coverage; if a conflict exists, the member’s contract or Certificate of Coverage governs. [[source]]
Certain policies may not apply to Self-Funded members and certain insured products — confirm coverage with the member-specific benefit plan document or Certificate of Coverage. [[source]]

Policy Applicability and Access

Policy applicability and access

Adopted policy setEffective January 1, 2026, Oxford will utilize the UnitedHealthcare Commercial Medical Policies for Oxford Commercial plans.

Where to access adopted policiesUHCprovider.com/policies > For Commercial Plans > Medical & Drug Policies.

Oxford clinical policy versionsOxford will no longer maintain duplicate Oxford-specific Medical (Clinical) Policy versions.

Administrative policies accessOxford Administrative Policies will retain the same external access that existed prior to January 1, 2026.

Coverage governed by member contractServices described in adopted policies remain subject to the terms, conditions, limitations, exclusions, and benefit language in the member's contract or Certificate of Coverage, which govern if differences exist.

Applicability exceptionsCertain policies may not apply to Self-Funded members and certain insured products; confirm coverage and exclusions in the member-specific benefit plan document or Certificate of Coverage.