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- Provider Information
- Behavioral Health Resources
- Claim Reconsideration and Appeals
- Claims and Member Information
- Clinical Practice Guidelines
- Cultural Competency Library
- Dual Complete (HMO SNP) Program
- Electronic Data Interchange (EDI)
- Pharmacy Program
- Reimbursement Policy
Welcome to the UnitedHealthcare Community Plan Health Professionals area for Delaware providers!
Here you will find the information, forms, manuals and links you need to conduct business with UnitedHealthcare Community Plan.
Attention Providers: Some phone numbers for UHC staff members have changed. Click "Contact Us" for the updated information.
Medicaid Managed Care Rule External FAQ’s (PDF 64.57 KB)
Medicaid Managed Care Rule Presentation (PDF 90.71 KB)
Important Phone Numbers and Websites - Contact Us (PDF 215.34 KB)
Click on the arrow above to view manuals and forms.
Provider Administrative Manuals
- Delaware Medicaid and DSHP Plus Long Term Care Provider Manual (PDF 1.65 MB)
- Quick Reference Guide for the UnitedHealthcare Administrative Guides (PDF 112.23 KB)
Group Disclosure of Ownership and Control of Interest Form click here (PDF 519.75 KB) for PDF version.
Individual Disclosure of Ownership and Control of Interest Form click here (PDF 427.75 KB) for PDF version.
- Gaucher's Disease Enzyme Therapy Prior Authorization Form (PDF 230.11 KB)
- Abortion Justification Form (PDF 64.27 KB)
- Behavioral Health Conversion of Benefits (PDF 71.92 KB)
- Member Education Request (PDF 142.27 KB)
- Obstetrical Needs Assessment (PDF 33.54 KB)
- Prior Authorization Fax Request Form (PDF 183.29 KB)
- Sleep Study FAQ (PDF 144.85 KB)
- Sleep Study Worksheet (PDF 192.95 KB)
- Sterilization - Awareness (PDF 82.57 KB)
- Sterilization - Consent (PDF 227.56 KB)
- UBH Provider
- Botulinum Toxins Prior Authorization Form (PDF 510.97 KB)
- HP Acthar Gel Prior Authorization Form (PDF 225.65 KB)
- Immune Globulin Prior Authorization Form (PDF 230.5 KB)
- Makena Prior Authorization Form (PDF 227.5 KB)
- Xolair Prior Authorization Form (PDF 510.06 KB)
Click on the arrow above to view provider educational materials.
Asthma Triggers (PDF 96.83 KB)
Blood Sugar (PDF 159.13 KB)
Care Providers and Quality Measures (PPTX 800.04 KB)
Hemoglobin A1c (PDF 178.36 KB)
Branding Article July 2011 (PDF 60.9 KB)
Disease Management Information (PDF 135.11 KB)
Electronic Tools & Resources for Home and Community Based Services (HCBS) and Long-Term Support Services (LTSS) Providers (PDF 62.2 KB)
Healthy First Steps (PDF 1.76 MB)
Online Prior Authorization Request Tool Instructions (PDF 115.98 KB)
Provider Portal Application Authorization Status Inquiry Instruction Sheet (PDF 179.5 KB)
Transportation Benefits (PDF 20.41 KB)
United Behavioral Health FAQ (PDF 184.12 KB)
Rebranding Bulletin (PDF 131.6 KB)
EDI Fact Sheet (PDF 1.53 MB)
ERA and EFT Fact Sheet (PDF 660.45 KB)
Getting Connected with EDI, EFT and ERA (PDF 147.57 KB)
Click on the arrow above to view information on medical injectables.
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
BioScrip (offers nursing services)
• also serves as a national home infusion provider for medical benefit medications
The following specialty pharmacies also provide certain types of specialty medications:
Network Specialty Pharmacy
Accredo (nursing services)
Option Care (nursing services)
CVS Caremark Specialty Pharmacy
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.
Click on the arrow above to view additional links and information.
- Cultural Competency https://www.thinkculturalhealth.hhs.gov/
- Medicaid Assistance Office http://www.dhss.delaware.gov/dhss/dmma/contact.html
- Advance Directives and Living Wills http://www.dhss.delaware.gov/dhss/dsaapd/advance.html
- Delaware Helpline (800) 464-HELP http://www.delaware211.org/
- Delaware Healthy Children Program http://www.dhss.delaware.gov/dss/dhcp.html
- United Behavioral Health (OptumHealth Behavioral Solutions) www.providerexpress.com
- NCQA http://www.ncqa.org/tabid/100/Default.aspx
Wellness Registry for Delaware Community Plan Providers
The Wellness Registry is a community services database that contains resources throughout the State of Delaware that can assist in meeting our member’s needs. It will help you connect members to wellness programs, such as health education and disease management classes. UniteHealthcare uses the Healthify database as the wellness registry.
To access the Wellness Registry:
- Click on the Link button at the top right of UHCprovider.com and sign in with your Optum ID
- From the Link Dashboard, navigate to the Menu at the top left and choose myData Connection Dashboard
- Then, from the myData Connection dashboard, click on the Community Resource Finder tile to access the Healthify Wellness Registry
UnitedHealthcare Community Plan received NCQA New Health Plan Accreditation on July 7, 2010. NCQA's mission is to improve the quality of health care, and participating in their accreditation process is voluntary. NCQA’s New Health Plan Accreditation Program applies to health plans that are less than 36 months old. The program is distinct from NCQA's MCO Accreditation Program. NCQA Accreditation is a nationally recognized evaluation that purchasers, regulators, and consumers can use to assess managed care plans.
Click on the arrow above to view the prior authorization archive.
Prior Authorization (PDF 221.84 KB) - Effective December 7, 2015
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).
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.