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Provider Information

Welcome to the UnitedHealthcare Community Plan Health Professionals area for Pennsylvania providers.

Here, you will find the information and links you need to conduct business with UHC Community Plan. Choose your topic of interest by selecting one of the left navigation buttons.

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	800-600-9007 Monday-Friday, 8 a.m. – 5 p.m.
Postal Mailing Address	UnitedHealthcare Community Plan 1001 Brinton Road Pittsburgh, PA 15221
Claims Mailing Address	UnitedHealthcare Community Plan PO Box 8207 Kingston, NY 12402-8207
Utlization Management Appeals Address	UnitedHealthcare Community Plan Attn: Grievances and Appeals PO Box 31364 Salt Lake City, UT 84131-0364
Claims Appeals Mailing Address	UnitedHealthcare Community Plan Attn: Grievances and Appeals PO Box 31364 Salt Lake City, UT 84131-0364

Manual and Forms

Provider Administrative Manual

Pennsylvania Administrative Guide (PDF 3.31 MB)

Medical Injectables

To review the clinical criteria/guidelines used to conduct medical necessity reviews, please use this link.

Forms

Bioscrip Hemo Factor Enrollment Form (PDF 35.26 KB)
Prior Authorization Fax Request Form (PDF 64.42 KB)
Prior Authorization List - CHIP (PDF 81.77 KB)
Medicaid Prior Authorization Listing (PDF 467.23 KB)
Periodicity Schedule (PDF 53.35 KB)
Rx Solns Hemo Factor Enrollment Form (PDF 85.68 KB)
Benefit Limit Exceptions (PDF 19.85 KB)
Hysterectomy (English) (PDF 13.79 KB)
Hysterectomy (Español) (PDF 12.12 KB)
Statewide Obstetrical Needs Assessment Form (ONAF) Letter (PDF 186.03 KB)
Obstetrical Needs Assessment Form (PDF 1.07 MB)
Prior Authorization Exception (PDF 15.52 KB)
Physician Certification Abortion (PDF 26.57 KB)
Recipient Abortion Statement (PDF 19.11 KB)
Sterilization (English) (PDF 178.92 KB)
Sterilization (Español) (PDF 188.84 KB)
Botulinum Toxins Prior Authorization Form (PDF 547.56 KB)
HP Acthar Gel Prior Authorization Form (PDF 506.35 KB)
Immune Globulin Prior Authorization Form (PDF 504.43 KB)
Makena Prior Authorization (PDF 485.92 KB)

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.