UnitedHealthcare Community Plan
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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.

Please remember 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. 

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

AHCCCS/Medicaid Developmentally Disabled (DD)

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

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

Children's Rehabilitative Services (CRS)

 

Appeals & Claim Disputes Mailing Address
UnitedHealthcare Community Plan
Attn: Complaint and Appeals Department
1 East Washington, Suite 800
Phoenix, AZ 85004

Appeals Mailing Address: 
UnitedHealthcare Community Plan
Attn: Complaint and Appeals Department 
1 East Washington, Suite 800 
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

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 800
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

Appeals & Claim Disputes Mailing Address
UnitedHealthcare Community Plan
Long Term Care Claims
Attn: Provider Claim Dispute Coordinator
1 E. Washington Street, Suite 800
Phoenix, AZ 85004

UnitedHealthcare Dual Complete (HMO SNP)

Appeals & 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

Tool Kits

Quick Reference Grid (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, DD, Long Term Care and UnitedHealthcare Dual Complete.

AHCCCS Dental Provider Benefits Matrix (PDF 133.56 KB)

This form provides information needed to properly document dental benefits provided through UnitedHealthcare Community Plan.

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.

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 (& 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.

Provider Links

(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. Click here (PDF 129.64 KB) to access the AHCCCS web site to download the 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.

Beginning on October 1, 2011, 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

HIPAA Information (PDF 49.87 KB)

Fraud and Abuse

We encourage our medical professionals and their staff to review the Fraud and Abuse information available on the AHCCCS website. https://www.azahcccs.gov/Fraud/ReportFraud/  It is a comprehensive guide that discusses your responsibilities about Fraud and Abuse.

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.

For physicians who do not want to buy-and-bill a specialty pharmacy medication that is covered on the Medical Benefit, they may choose to source it through a network specialty pharmacy:

Network Specialty Pharmacy

Phone Number

OptumRx

866-218-7398

BioScrip (offers nursing services)

• also a National Home Infusion Provider for Medical Benefit medications

866-788-7710

The following specialty pharmacies may also provide specific categories of specialty pharmacy medications:

Network Specialty Pharmacy

Medication Category

Phone Number

Accredo (offers nursing services)

Enzyme Deficiency

Gaucher's Disease

Immune Globulin

Pulmonary Hypertension

800-803-2523

 

Walgreens Infusion Services (offers nursing services)

Cardiovascular/Heart Failure

Enzyme Deficiency

Gaucher's Disease

Hemophilia

Immune Globulin

Makena

866-827-8203

CVS Caremark Specialty Pharmacy

Enzyme Deficiency

Gaucher's Disease

Makena

Pulmonary Hypertension

800-237-2767

Coverage of the requested drug is dependent on the member's benefits, and the availability of a specific drug from a network specialty pharmacy may vary.

The Specialty Pharmacy can deliver the medication to the healthcare practitioner's office or another site (ex. patient's home) upon request, and the Specialty Pharmacy will bill the patient's health plan directly.

Archive

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
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 Policies and Coverage Determination Guidelines

 

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 38.15 KB) to download our policy.

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