UnitedHealthcare Community Plan
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UnitedHealthcare Community Plan Delaware Providers

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.

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

 

Option Care (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.

Helpful Links & Information

Health Plan NCQA AccreditationUnitedHealthcare 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.

 

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

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.