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Provider Information

Welcome to the UnitedHealthcare Community Plan Health Professionals area for New York providers!

Here you will find the information, forms, manuals and links you need to conduct business with UnitedHealthcare Community Plan.

Please choose your topic of interest, by selecting one of the navigation buttons on the left-hand side of the page, or select one of the topics or products below to reveal our Contact Information, Provider Administrative Manuals and Forms.

Contact Us

Provider Call Center	877-842-3210
Postal Mailing Address	UnitedHealthcare Community Plan 77 Water Street, 14th Floor New York, NY 10005
Claims Mailing Address	UnitedHealthcare Community Plan PO Box 5240 Kingston, NY 12402-5240
Utlization Management Appeals Address	UnitedHealthcare Community Plan PO Box 31364 Salt Lake City, UT 84131-0364
Claims Appeals Mailing Address	UnitedHealthcare Community Plan Attn: Complaint and Appeals Department PO Box 31364 Salt Lake City, UT 84131-0364

UnitedHealthcare Community Plan for Families

Provider Administrative Manuals

New York Physician, Health Care Professional, Facility and Ancillary Administrative Guide (PDF 3.39 MB)
New York Administrative Guide Supplement (PDF 47.91 KB)

Prior Authorization Fax Request Form (PDF 90.13 KB)
Bioscrip Hemo Factor Enrollment Form (PDF 44.6 KB)
Addendum A (PDF 14.08 KB)

UnitedHealthcare Community Plan for Kids

Provider Administrative Manuals

New York Physician, Health Care Professional, Facility and Ancillary Administrative Guide (PDF 3.39 MB)
New York Administrative Guide Supplement (PDF 47.91 KB)

Prior Authorization Fax Request Form (PDF 90.13 KB)
Bioscrip Hemo Factor Enrollment Form (PDF 44.6 KB)
Addendum A (PDF 14.08 KB)

UnitedHealthcare Community Plan for Adults

Provider Administrative Manuals

New York Physician, Health Care Professional, Facility and Ancillary Administrative Guide (PDF 3.39 MB)
New York Administrative Guide Supplement (PDF 47.91 KB)

Prior Authorization Fax Request Form (PDF 90.13 KB)
Bioscrip Hemo Factor Enrollment Form (PDF 44.6 KB)
Addendum A (PDF 14.08 KB)

UnitedHealthcare Community Plan Managed Long Term Care

Provider Administrative Manuals

New York Physician, Health Care Professional, Facility and Ancillary Administrative Guide (PDF 3.39 MB)

CPT (Current Procedural Terminology) Codes

Radiology Crosswalk Table (PDF 469.08 KB)
Radiology Prior Authorization List - Medicaid (PDF 235.92 KB)
Radiology Prior Authorization List - Dual Advantage (PDF 236.21 KB)

Downloadable Directories

These directories list the names and addresses of health care professionals and facilities within this health plan. Each directory can be printed or saved to your computer.

Upstate New York (PDF 4.53 MB)
Upstate New York (Rockland and Westchester) (PDF 3.56 MB)
Upstate New York (Broome, Chenango, Clinton, Jefferson, Tioga and Warren) (PDF 2.76 MB)
Downstate New York (PDF 7.32 MB)
Downstate (Manhattan and Bronx) (PDF 6.6 MB)
Downstate (Kings and Richmond) (PDF 5.92 MB)
Personal Care Services Supplemental Directory (PDF 203.85 KB)

Medical Injectables

To review the clinical criteria/guidelines used to conduct medical necessity reviews, please use this link: https://www.unitedhealthcareonline.com/b2c/CmaAction.do?channelId=ca174ccb4726b010VgnVCM100000c520720a____

Clinical Information- UnitedHealthcare Medical Policies

UnitedHealthcare has developed Medical Policies, 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.

For Medicare Medical Policies, please click 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. Click here (PDF 34.75 KB) to download our policy.

Disclaimer

If UHG Medical 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.