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UnitedHealthcare Community Plan Added to Electronic Payments & Statements (PDF 59.89 KB)

Medicaid Managed Care Rule External FAQ’s (PDF 64.57 KB)

Medicaid Managed Care Rule Presentation (PDF 90.71 KB)

 

Provider Manual

Care Provider Manual (PDF 1.62 MB) - 10.10.2017

Quick Reference Guide for the UnitedHealthcare Administrative Guides (PDF 112.23 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 WA - Effective 7/1/2017 (PDF 235.5 KB)

UnitedHealthcare Community Plan Prior Authorization WA - Effective 4/1/2017 (PDF 225.06 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 1/1/2017 (PDF 306.96 KB)

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

UnitedHealthcare Community Plan Prior Authorization WA - Effective 1/1/2017 (PDF 225.54 KB)

UnitedHealthcare Community Plan Prior Authorization WA - Effective 10/1/2016 (PDF 219.2 KB)

UnitedHealthcare Medicare Solutions and UnitedHealthcare Community Plan Notification / Prior Authorization Requirements -  Effective 10/1/2016 (PDF 277.31 KB)

UnitedHealthcare Community Plan Prior Authorization WA - Effective 7/1/2016 (PDF 213.47 KB)

UnitedHealthcare Medicare Solutions and UnitedHealthcare Community Plan Notification/Prior Authorization Requirements - Effective 7/1/2016 (PDF 266.74 KB)

UnitedHealthcare Medicare Solutions and UnitedHealthcare Community Plan Notification/Prior Authorization Requirements - Effective 5/1/2016 (PDF 251.42 KB)

UnitedHealthcare Community Plan Prior Authorization List WA - Effective 5/1/2016 (PDF 215.72 KB)

UnitedHealthcare Medicare Solutions Notification/Prior Authorization List - Effective 1/1/16 (PDF 250.02 KB)

UnitedHealthcare Medicare Solutions Notification/Prior Authorization List - Effective 1/1/16 (PDF 249.77 KB)

Advance Notification Requirements - Effective 10/1/2014 (PDF 186.05 KB)

 

Medical Injectables

Specialty pharmacy medications covered on the Medical Benefit may be provided through a variety of channels – home infusion provider, outpatient facility, physician, or specialty pharmacy.

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.

News

Fostering Positive Youth Development: Opportunities to Reframe the Conversation About Trauma
April 1, 2016, 10:00–11:00 a.m. How might we create school systems and services that engage young people to improve their experience of school climate and wellness? This webinar will explore frameworks and approaches for developing effective youth leadership and positive school climate in your school community, unpacking how and why youth voice is essential to building healthy school climates and cultures. Specific challenges with youth engagement will be discussed.

Self and Collective Care of Youth-Serving Adults
April 8, 2016, 10:00–11:00 a.m. Students are at the center of our work. At the same time, adults in our school communities need support in order to show up for the young people they serve. This webinar will explore how we can create cultures of care not only for youth, but also for the adults who work with them. 



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).

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.