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Dual Complete (HMO SNP) Program

 

Effective January 1, 2017 UnitedHealthcare Community Plan of Delaware launches a new Dual Special Needs Plan (DSNP) – UnitedHealthcare Dual Complete (HMO SNP), in New Castle County.

 

A Special Needs Plan is a Medicare Advantage (MA) coordinated care plan that provides targeted care and services to individuals with unique needs. Dual Special Needs Plans are plans for members eligible for Medicare and Medicaid.

Dual Special Needs Plans must:

  • Follow CMS regulations and cover all Medicare Part A (hospital stay) and Part B (doctor’s office) benefits, and must include Medicare Part D (pharmacy) coverage.
  • Offer clinical programs and special expertise to serve the target population.

UnitedHealthcare Dual Complete program will reimburse claims, according to your UnitedHealthcare contractual Medicare fee schedule.

This page is dedicated to information specific to the Dual Complete program. Look here for provider resources including administrative guide, quick reference guide, provider directory, policies and news related to the Dual Compete program.


Provider Resources

Administrative Guide 

Search for a Provider – Dual Complete Provider Directory

Dual Complete Pharmacy Formulary 

 

Provider Documents

Dual Complete Provider  Quick Reference Guide (PDF 750.9 KB) 

 

Coverage Summaries and Reimbursement Policies

UnitedHealthcare Medicare Advantage Coverage Summaries

UnitedHealthcare Medicare Advantage Reimbursement Policies

Additional Medicare Advantage Policies

Medicare Advantage Prior Authorization Protocols


Link and UHCprovider.com 

Use Link to perform secure transactions such as checking member eligibility and benefits, managing claims and requesting prior authorization. To access Link, sign in to UHCprovider.com using your Optum ID.

If you don’t have an Optum ID, go to UnitedHealthcareOnline.com and select “New User” to begin registration.

  • To learn more about using Link, please visit UHCprovider.com > Tools & Resources > Health Information Technology > Link