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UnitedHealthcare Community Plan Arizona Providers

You don't have time to spare: that's why we put all the documents you need in one place.

Use the navigation items on the left to find what you're looking for fast.

Providers are encouraged to check our website frequently for updates regarding reimbursement policies, provider manuals and bulletins, providing information to our provider network of changes throughout the year.  

Provider Call Center: 800-445-1638
Hours of Operation: 8:00 am-5:00 pm CST

Mailing Address:
UnitedHealthcare Community Plan
1 East Washington, Suite 900
Phoenix, AZ 85004

Claims & Medical Records Mailing Address:
UnitedHealthcare Community Plan
PO Box 5290
Kingston, NY 12402-5290

Member Appeals & Provider Claim Disputes Mailing Address
UnitedHealthcare Community Plan
Attn: Appeals & Claim Disputes
1 East Washington, Suite 900
Phoenix, AZ 85004

Behavioral Health Claims & Medical Records Mailing Address:
United Behavioral Health
PO Box 30760
Salt Lake City, UT 84130-0760

 

Member Appeals & Provider Claim Disputes Mailing Address
UnitedHealthcare Community Plan
Attn: Complaint and Appeals Department
1 East Washington, Suite 900
Phoenix, AZ 85004

Appeals Mailing Address: 
UnitedHealthcare Community Plan
Attn: Complaint and Appeals Department 
1 East Washington, Suite 900 
Phoenix, AZ 85004

Mailing Address:
UnitedHealthcare Community Plan
1 East Washington, Suite 900
Phoenix, AZ 85004

Claims & Medical Records Mailing Address:
UnitedHealthcare Community Plan
PO Box 5290
Kingston, NY 12402-5290

Behavioral Health Claims & Medical Records Mailing Address:
United Behavioral Health
PO Box 30760
Salt Lake City, UT 84130-0760

Long Term Care Provider Call Center: 1-800-293-3740

Hours of Operation: 8:00 am- 5:00 pm Arizona Time

Mailing Address:
UnitedHealthcare Community Plan
1 East Washington, Suite 900
Phoenix, AZ 85004

Claims & Medical Records Mailing Address for Dates of Service before April 1, 2016
UnitedHealthcare Community Plan
P. O. Box 30995
Salt Lake City, UT 84130

Claims & Medical Records Mailing Address for Dates of Service on/after April 1, 2016
UnitedHealthcare Community Plan
P.O. Box 5290
Kingston, NY 12402-5290

Member Appeals & Provider Claim Disputes Mailing Address
UnitedHealthcare Community Plan
Long Term Care Claims
Attn: Provider Claim Dispute Coordinator
1 E. Washington Street, Suite 900
Phoenix, AZ 85004

Behavioral Health Claims & Medical Records Mailing Address:
United Behavioral Health
PO Box 30760
Salt Lake City, UT 84130-0760

Member Appeals & Provider Claim Disputes Mailing Address
UnitedHealthcare Dual Complete
Attn: Appeals
PO Box 31364
Salt Lake City, UT 84131-0364

Part C Appeals and Grievance Department
UnitedHealthcare Community Plan
Attn: Complaint and Appeals Department
P.O. Box 31364
Salt Lake City, UT 84131-0364

Part D Appeals and Grievance Department
Attn: CA124-0197
P.O. Box 6106
Cypress, CA 90630

Mailing Address:
UnitedHealthcare Community Plan
1 East Washington, Suite 900
Phoenix, AZ 85004

Claims & Medical Records Mailing Address:
UnitedHealthcare Community Plan
PO Box 5290
Kingston, NY 12402-5290

Behavioral Health Claims & Medical Records Mailing Address:
United Behavioral Health
PO Box 30760
Salt Lake City, UT 84130-0760

AHCCCS Dental Provider Benefits Matrix (PDF 133.56 KB) - Provides information needed to properly document dental benefits provided through UnitedHealthcare Community Plan.

CRSA Peer Review Process (PDF 481.81 KB) - This document describes the CRSA Peer Review Process.

Establishing and Documenting in the Medical Record (PDF 62.15 KB) - Guidelines for physicians to ensure that a medical record is established.

Integrity of Claims, Reports, and Representations to the Government (PDF 38.15 KB) - UnitedHealth Group and AmeriChoice requires compliance with the requirements of federal and state laws that prohibit the submission of false claims in connection with federal health care programs, including Medicare and Medicaid.

Interpreter Services List (PDF 23.28 KB) - A source of translation services for members who are in need of an interpreter.

Language Line - Interpretation Service Guide (PDF 156.09 KB) - This guide provides information for providers who require interpretation services when providing care to UnitedHealthcare Community Plan members.

Personal Care Plus Appeals (PDF 24.38 KB) - This document provides updated information on filing claims appeals with UnitedHealthcare Community Plan.

Quick Reference Grid for UnitedHealthcare Community Plan Programs (PDF 878.35 KB) - Use this quick reference grid to find important guidelines, vendors and contact information for all UnitedHealthcare Community Plan programs: AHCCCS/Medicaid, CRS, Developmentally Disabled, Long Term Care, and UnitedHealthcare Dual Complete.

Transfer of Behavioral Health Care from Primary Care Physician (PCP) to the Regional Behavioral Health Authorities (RBHA) (PDF 63.04 KB) - When a patient is transferred from a PCP to a RBHA network physician for ongoing behavioral health care, it is required that the PCP coordinate this transfer of care.

Trauma-Informed Care and Services (On-Demand Education) (PDF 606.23 KB) - A three-part educational series for physicians, nurses, behavioral health clinicians and therapists, social workers (all practice types), peer support specialists, foster parents, residential placement staff and others who have an interest in topics relevant to child welfare.

(AHCCCS) Arizona Health Care Cost Containment System - AHCCCS is Arizona's Medicaid program, designed to deliver quality health care under cutting-edge concepts of managed care. Over the years, independent evaluations repeatedly have praised the program's effectiveness. AHCCCS has received national acclaim as a model for other Medicaid programs.

(AHCCCS) Performance Measures - Performance Measures as defined by Arizona Health Care Cost Containment System.

AHCCCS Chapter 10 FQHC / RHC Addendum

Arizona Department of Health Services - Arizona Department of Health Services web site has comprehensive list of services provided.

Best Available Evidence - CMS created the best available evidence (BAE) policy in 2006, requiring sponsors to establish the appropriate cost-sharing for low-income beneficiaries when presented with evidence that the beneficiary's information is not accurate.

Claims and Payments - Research and remits for claims and claims status.

CMS / Centers for Medicare and Medicaid Services - The Centers for Medicare & Medicaid Services (CMS) is a Federal agency within the U.S. Department of Health and Human Services. Programs for which CMS is responsible include Medicare, Medicaid, State Children's Health Insurance Program (SCHIP), HIPAA, and CLIA.

Children's Rehabilitative Services - Office for Children with Special Health Care Needs web site shows how to improve the quality of life for children by providing family-centered medical treatment, rehabilitation, and related support services.

Clinician Resources - The UnitedHealth Premium® physician designation program uses clinical information from health care claims to assist physicians in their continuous practice improvement and to help consumers make more informed and personally appropriate choices for their medical care.

Contractor Performance Measure Results (PDF 76.97 KB)

CRS Behavioral Health - For CRS Behavioral Health claim status, demographics updates, or for Behavioral Network Services contact information log-in to Secure Transactions.

Dental Provider Benefits Matrix for UnitedHealthcare Community Plan Members (PDF 144.24 KB) - Dental services are limited to members under age 21 except for a limited set of services as indicated on the matrix.

Department Of Health & Human Services - Website for the United States Department of Health & Human Services. Administrative Simplification in the Health Care Industry

Early and Periodic Screening Diagnosis and Treatment Tracking Forms (PDF 129.64 KB) - Appendix B of the AHCCCS Medical Policy Manual contains several Early and Periodic Screening Diagnosis and Treatment Tracking Forms for specific time periods. View the AHCCCS site (PDF 129.64 KB) to download forms or to order hard copies from UnitedHealthcare Community Plan.

HIPAA - THE HIPAA privacy, security, transactions and code sets, and national identifiers resource on regulations and compliance for the healthcare industry.

HealthFinder® - Since 1997, Healthfinder® has been recognized as a key resource for finding the best government and nonprofit health and human services information on the Internet. Healthfinder links to carefully selected information and Web sites from over 1,700 health-related organizations.

Immunization Schedules - Link to latest recommended Immunization Schedules.

Lead Poisoning Awareness (PDF 403.38 KB)- Lead poisoning, which is a severe problem in Arizona, is a life altering disease that is 100% preventable.

Long Term Care Contractor Specific Performance Measure Results (PDF 36.3 KB)

Low-Cost/No-Cost Clinic Resources in Arizona - New interactive web site to help people easily locate a clinic that provides free or low cost primary, family planning, mental and dental health services to people without health insurance.

Medicare.gov - The Official U.S. Government Site for People with Medicare.

Medical Policies - UnitedHealthcare Community Plan medical policies are available to you as a general reference resource.

When these medical policies are used to determine medical necessity, clinical guidelines will be applied in the following order: 1) AHCCCS Medical Policy Manual (AMPM) as it is updated; 2) UnitedHealthcare guidelines; and 3) "Milliman" guidelines.

Notifications and Prior Authorization - Electronic notifications, prior authorization requests and referral requests.

Pediatric Care Guidelines - The American Academy of Pediatrics provides organizational principles that guide and define the child health care system with a goal of improving the health of all children. Their web site also provides decision-making tools for managing common pediatric conditions.

HIPAA Information (PDF 49.87 KB)

We encourage our medical professionals and their staff to review the Fraud and Abuse information available on the AHCCCS website. The comprehensive guide discusses your responsibilities as a provider for  Fraud and Abuse.

View the Fraud and Waste guide

Report Health Care Fraud, Waste and Abuse: 844-359-7736 or uhc.com/fraud

Specialty pharmacy medications covered under the member's medical benefit may be obtained through various sources ‒ home infusion providers, outpatient facilities, physicians or specialty pharmacy.

If you don't want to buy and bill a specialty pharmacy medication covered under the member's medical benefit, you may order it through one of the following network specialty pharmacies:

Network Specialty Pharmacy

Phone Number

BriovaRx

866-815-5338

BioScrip (offers nursing services)

• also serves as a national home infusion provider for medical benefit medications

866-788-7710

The following specialty pharmacies also provide certain types of specialty medications:

Network Specialty Pharmacy

Medication Category

Phone Number

Accredo (nursing services)

Enzyme Deficiency

Gaucher's Disease

Immune Globulin

Pulmonary Hypertension

800-803-2523

 

Option Care (nursing services)

Cardiovascular/Heart Failure

Enzyme Deficiency

Gaucher's Disease

Hemophilia

Immune Globulin

Makena

866-827-8203

CVS Caremark Specialty Pharmacy

Pulmonary Hypertension

800-237-2767


Coverage of a requested medication depends on the member’s benefit, and availability of a specific drug from a network specialty pharmacy may vary.

Upon request, a specialty pharmacy can deliver the medication to your office or another site such as a member’s home.

Medications obtained through a specialty pharmacy will be directly billed to the patient’s health plan.

CRS Behavioral Health Out-of-Home Request (PDF 74.04 KB)

UnitedHealthcare Medicare Solutions & UnitedHealthcare Community Plan
UnitedHealthcare Medicare Prior Authorization Requirements - Effective 10/1/2017 (PDF 286.74 KB)

UnitedHealthcare Community Plan - Acute Medicaid
UnitedHealthcare Community Plan Prior Authorization AZ Acute - Effective 10/1/2017 (PDF 308.54 KB)

UnitedHealthcare Community Plan - Children's Rehabilitative Services
UnitedHealthcare Community Plan Prior Authorization AZ CRS - Effective 10/1/2017 (PDF 378.74 KB)

UnitedHealthcare Community Plan - Developmentally Disabled
UnitedHealthcare Community Plan Prior Authorization AZ DD - Effective 10/1/2017 (PDF 305.51 KB)

UnitedHealthcare Community Plan - Long Term Care
UnitedHealthcare Community Plan Prior Authorization AZ LTC - Effective 10/1/2017 (PDF 141.1 KB)

UnitedHealthcare Medicare Solutions and UnitedHealthcare Community Plan-Medicare Notification/Prior Authorization Requirements - Effective 7/1/2017 (PDF 300.09 KB)

UnitedHealthcare Community Plan Prior Authorization AZ Acute - Effective 7/1/2017 (PDF 302.58 KB)

UnitedHealthcare Community Plan Prior Authorization AZ CRS - Effective 7/1/2017 (PDF 372.08 KB)

UnitedHealthcare Community Plan Prior Authorization AZ DD - Effective 7/1/2017 (PDF 297.21 KB)

UnitedHealthcare Community Plan Prior Authorization AZ LTC - Effective 7/1/2017 (PDF 268.66 KB)

UnitedHealthcare Community Plan Prior Authorization AZ Acute - Effective 4/1/2017 (PDF 304.03 KB)

 

UnitedHealthcare Community Plan Prior Authorization AZ CRS - Effective 4/1/2017 (PDF 375.89 KB)

UnitedHealthcare Community Plan Prior Authorization AZ DD - Effective 4/1/2017 (PDF 299 KB)

UnitedHealthcare Community Plan Prior Authorization AZ LTC - Effective 4/1/2017 (PDF 267.25 KB) 

UnitedHealthcare Medicare Solutions and UnitedHealthcare Community Plan-Medicare Notification/Prior Authorization Requirements - Effective 5/1/2017 (PDF 299.55 KB) 

UnitedHealthcare Medicare Solutions and UnitedHealthcare Community Plan-Medicare Notification/Prior Authorization Requirements - Effective 4/1/2017 (PDF 300.79 KB)

UnitedHealthcare Medicare Solutions and UnitedHealthcare Community Plan-Medicare Notification / Prior Authorization Requirements -  Effective 1/1/2017 (PDF 306.96 KB)

Dual Complete Prior Authorization and Notification Requirements -  Effective 7/1/2016 (PDF 214.92 KB)

UnitedHealthcare Community Plan Prior Authorization AZ Acute - Effective 1/1/2017

UnitedHealthcare Community Plan Prior Authorization AZ CRS - Effective 1/1/2017 (PDF 371.65 KB)

UnitedHealthcare Community Plan Prior Authorization AZ DD - Effective 1/1/2017

UnitedHealthcare Community Plan Prior Authorization AZ LTC - Effective 1/1/2017

UnitedHealthcare Community Plan Prior Authorization AZ Acute - Effective 10/1/2016

UnitedHealthcare Community Plan Prior Authorization AZ CRS - Effective 10/1/2016

UnitedHealthcare Community Plan Prior Authorization AZ DD - Effective 10/1/2016 (PDF 292.52 KB)

 UnitedHealthcare Community Plan Prior Authorization AZ LTC - Effective 10/1/2016 (PDF 268.39 KB)

 UnitedHealthcare Community Plan Prior Authorization AZ CRS - Effective 7/1/2016 (PDF 315.49 KB)

UnitedHealthcare Community Plan Prior Authorization AZ Acute - Effective 8/1/2016 (PDF 294.83 KB)

UnitedHealthcare Community Plan Prior Authorization AZ DD - Effective 8/1/2016 (PDF 283.57 KB)

UnitedHealthcare Community Plan Prior Authorization AZ LTC - Effective 7/1/2016 (PDF 265.2 KB)

UnitedHealthcare Community Plan Prior Authorization AZ Acute - Effective 7/1/2016 (PDF 282.02 KB)

UnitedHealthcare Community Plan Prior Authorization AZ DD - Effective 7/1/2016 (PDF 269.28 KB)

Dual Complete Prior Authorization and Notification Requirements - Effective 1/1/2016 (PDF 226.07 KB)

 AZ Acute/DDD Prior Authorization List - Effective 5/1/2016 (PDF 284.7 KB)

AZ CRS Prior Authorization List - Effective 5/1/2016 (PDF 296.84 KB)

AZ Long Term Care Prior Authoriztion List - Effective 5/1/2016 (PDF 278.9 KB)

AZ Acute/DDD Prior Authorization List - Effective 1/1/2016 (PDF 284.22 KB)

AZ CRS Prior Authorization List - Effective 1/1/2016 (PDF 281.25 KB)

AZ Long Term Care Prior Authorization List - Effective 1/1/2016 (PDF 274.16 KB)

AZ Prior Authorization Fax Request Form - Effective 10/1/2015 (PDF 74.88 KB)

Long Term Care General Prior Authorization Request (PDF 82.56 KB)

Dual Complete Prior Authorization and Notification Requirements - Effective 1/1/2016 (PDF 175.74 KB)

AZ Acute/DDD Prior Authorization List - Effective 1/1/2016 (PDF 175.74 KB)

AZ CRS Prior Authorization List - Effective 1/1/2016 (PDF 159.55 KB)

AZ Long Term Care Prior Authorization List - Effective 1/1/2016 (PDF 181.11 KB)

UnitedHealthcare Medicare Solutions Notification/Prior Authorization List - Effective 1/1/2016 (PDF 250.02 KB)

AZ Acute/DDD Prior Authorization List - Effective 12/7/2015 (PDF 382.73 KB)

AZ CRS Prior Authorization List - Effective 12/1/2015 (PDF 702.05 KB)

AZ Long Term Care Prior Authorization List - Effective 12/7/2015 (PDF 229.9 KB)

UnitedHealthcare Medicare Solutions Notification/Prior Authorization List - Effective 1/1/2016 (PDF 249.77 KB)

AZ Acute/DDD Prior Authorization list effective 10/1/2015 (PDF 177.72 KB)

AZ CRS Prior Authorization list effective 10/1/2015 (PDF 208.41 KB)

AZ Long Term Care Prior Authorization list effective 10/1/2015 (PDF 745.21 KB)

 

UnitedHealthcare Community Plan Medical & Drug Policies and Coverage Determination Guidelines

UnitedHealthcare has developed Medical Policies, Medical Benefit 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 the guidelines

UnitedHealthcare Medicare Advantage Coverage Summaries

For policy guidance for Medicare Advantage plan members, view the UnitedHealthcare Medicare Advantage Coverage Summaries Manual and corresponding policy update bulletins here

Integrity of Claims, Reports, and Representations to the Government

UnitedHealth Group requires compliance with the requirements of federal and state laws that prohibit the submission of false claims in connection with federal health care programs, including Medicare and Medicaid. 
View our policy (PDF 38.15 KB).

2014 UnitedHealthcare Community Plan Physician Satisfaction Results (PDF 76.97 KB)

Disclaimer

If UHG policies conflict with provisions of a state contract or with state or federal law, the contractual / statutory / regulatory provisions shall prevail. To see updated policy changes, select the Bulletin section at left.