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


Florida M*Plus (MMA) Continuity/Transition of Care Information
(PDF 67.83 KB)


CareCore Pre-Certifications

Injectable Chemotherapy - Effective May 17, 2014, UnitedHealthcare will implement a new Injectable Chemotherapy Prior Authorization Program in Florida. This is a new requirement for UnitedHealthcare Community Plan (excluding UnitedHealthcare at Home and UnitedHealthcare’s Health & Home Connection membership, formerly known as Evercare) members.

·   Prior authorization for outpatient injectable chemotherapy is required for the treatment of cancer.
·   Prior authorization request must be submitted on CareCore National’s website: medicaloncologyauthorizations.com.  We request that all prior authorizations be completed online.  If you are experiencing internet connection problems or have a question you may call 855-252-1116 Monday through Friday from 7 a.m. to 7 p.m. (EST).   

Click here to view the program summary, frequently asked questions and register for a training session via WebEx. 

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

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.

 

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.