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)

EAPG Payment Methodology Implementation for Hospitals and Ambulatory Surgical Centers (PDF 124.39 KB)

Report Health Care Fraud, Waste and Abuse: 844-359-7736 or uhc.com/fraud


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. 

Prior Authorization Archive

Click on the arrow above to view the prior authorization archive.

UnitedHealthcare Community Plan Prior Authorization FL - Effective 7/1/2017 (PDF 221.33 KB)

UnitedHealthcare Community Plan Prior Authorization FL - Effective 6/1/2017 (PDF 221.31 KB)

UnitedHealthcare Medicare Solutions and UnitedHealthcare Community Plan-Medicare Notification/Prior Authorization Requirements - Effective 5/1/2017 (PDF 299.55 KB)

UnitedHealthcare Community Plan Prior Authorization FL - Effective 4/1/2017 (PDF 218.33 KB)

UnitedHealthcare Medicare Solutions and UnitedHealthcare Community Plan-Medicare Notification/Prior Authorization Requirements - Effective 1/1/2017 (PDF 306.96 KB)

UnitedHealthcare Medicare Solutions and UnitedHealthcare Community Plan-Medicare Notification/Prior Authorization Requirements - Effective 4/1/2017 (PDF 300.79 KB)

UnitedHealthcare Community Plan Prior Authorization FL - Effective 2/1/2017 (PDF 214.63 KB)

UnitedHealthcare Community Plan Prior Authorization FL - Effective 1/1/2017 (PDF 211.49 KB)

UnitedHealthcare Community Plan Prior Authorization FL - Effective 10/1/2016 (PDF 213.96 KB)

UnitedHealthcare Medicare Solutions and UnitedHealthcare Community Plan Notification / Prior Authorization Requirements -  Effective 10/1/2016 (PDF 277.31 KB)

UnitedHealthcare Community Plan Prior Authorization FL - Effective 10/1/2016 (PDF 213.96 KB)

UnitedHealthcare Community Plan Prior Authorization FL Effective 7/1/2016 (PDF 195.49 KB)

UnitedHealthcare Medicare Solutions and UnitedHealthcare Community Plan Notification/Prior Authorization Requirements Effective 7/1/2016 (PDF 266.74 KB)

UnitedHealthcare Medicare Solutions and UnitedHealthcare Community Plan Notification/Prior Authorization Requirements Effective 5/1/2016 (PDF 251.42 KB)

UnitedHealthcare Community Plan Prior Authorization FL - Effective 5/1/2016 (PDF 197.68 KB)

UnitedHealthcare Medicare Solutions Notification/Prior Authorization List - Effective 1/1/16 (PDF 250.02 KB)

UnitedHealthcare Community Plan Prior Authorization - Effective 12/7/2015 (PDF 173.01 KB)

UnitedHealthcare Medicare Solutions Notification/Prior Authorization List - Effective 1/1/16 (PDF 249.77 KB)

Advance Notification Requirements for Florida, Effective 6/1/2015 (PDF 173.6 KB)

Advance Notification Requirements for Florida, Effective 3/1/2015 (PDF 467.44 KB)

 

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.

Medical Injectable Information

Click on the arrow above to view more information about medical injectables. 

Specialty pharmacy medications covered under the member's medical benefit may be obtained through various sources ‒ home infusion providers, outpatient facilities, physicians or specialty pharmacy.

If you don't want to buy and bill a specialty pharmacy medication covered under the member's medical benefit, you may order it through one of the following network specialty pharmacies:

Network Specialty Pharmacy

Phone Number

BriovaRx

866-815-5338

BioScrip (offers nursing services)

• also serves as a national home infusion provider for medical benefit medications

866-788-7710

The following specialty pharmacies also provide certain types of specialty medications:

Network Specialty Pharmacy

Medication Category

Phone Number

Accredo (nursing services)

Enzyme Deficiency

Gaucher's Disease

Immune Globulin

Pulmonary Hypertension

800-803-2523

 

Option Care (nursing services)

Cardiovascular/Heart Failure

Enzyme Deficiency

Gaucher's Disease

Hemophilia

Immune Globulin

Makena

866-827-8203

CVS Caremark Specialty Pharmacy

Pulmonary Hypertension

800-237-2767


Coverage of a requested medication depends on the member’s benefit, and availability of a specific drug from a network specialty pharmacy may vary.

Upon request, a specialty pharmacy can deliver the medication to your office or another site such as a member’s home.

Medications obtained through a specialty pharmacy will be directly billed to the patient’s health plan.

 

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

UnitedHealthcare Medicare Advantage Coverage Summaries

For policy guidance for Medicare Advantage plan members, view the UnitedHealthcare Medicare Advantage Coverage Summaries Manual and corresponding policy update bulletins here

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.