UnitedHealthcare Community Plan
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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.

UnitedHealthcare Responds to Ebola Concerns (PDF 80.08 KB)

Note: UnitedHealthcare Community Plan's Portal will be a historic portal only and will display claims and eligibility for dates of services prior to 3/1/14.  If you are looking for details on Member Eligibility or Claim Status for dates of service on or after 3/1/14, please use UnitedHealthcare Online. If you do not already have access to UnitedHealthcare Online, you will need to register as a new user. 

Note: DMAP is now accepting attestations from Delaware providers eligible to receive the PPACA increase for certain E&M and VFC fees.  Providers attesting before June 30 will be eligible for retroactive payments at the Medicare Part B rate back to January 1, 2013.  Attestations completed after July 1 will authorize increase payments as of the effective date only. Click here for more information.

Attention Providers: Some phone numbers for UHC staff members have changed. Click "Contact Us" for the updated information.

Manuals and Forms

Provider Administrative Manuals
 

Forms

Group Disclosure of Ownership and Control of Interest Form click here (PDF 591.54 KB) for PDF version.

Individual Disclosure of Ownership and Control of Interest Form click here (PDF 314.53 KB) for PDF version.

Provider Education

Asthma Triggers (PDF 96.83 KB)
Blood Sugar (PDF 159.13 KB) 
Hemoglobin A1c (PDF 178.36 KB)
Branding Article July 2011 (PDF 60.9 KB)
Disease Management Information (PDF 135.11 KB)
Healthy First Steps (PDF 1.76 MB)
Online Prior Authorization Request Tool Instructions (PDF 115.98 KB)
Provider Portal Application Authorization Status Inquiry Instruction Sheet (PDF 179.5 KB)
Transportation Benefits (PDF 20.41 KB)
United Behavioral Health FAQ (PDF 184.12 KB)

Bulletins
Rebranding Bulletin (PDF 131.6 KB)

EDI Category
EDI Fact Sheet (PDF 1.53 MB)
ERA and EFT Fact Sheet (PDF 660.45 KB)
Getting Connected with EDI, EFT and ERA (PDF 147.57 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____

 

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

888-296-4513

 

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.

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 through a network specialty pharmacy:

Network Specialty Pharmacy

Phone Number

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

888-296-4513

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.

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 Policies and Coverage Determination Guidelines (PDF 243.38 KB)

 

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.