UnitedHealthcare Community Plan
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We continue to ensure that all documents are updated for ICD-10 Terminology. Providers should be aware that ICD-9 content applies to dates of service prior to 10/1/2015. ICD-10 terminology and claims sets apply to dates of service 10/1/2015 and after, regardless of the status of the document. 

Please select the state where you practice.

UnitedHealthcare Community Plan New Mexico Providers

You don't have time to spare: that's why we put all the documents you need in one place. Use the navigation items on the left to find what you're looking for fast

Contact Information

If you have questions about the UnitedHealthcare Community Plan of New Mexico, Centennial Care, please contact your established Provider Advocate or our Provider Call Center at 888-702-2202, and we will be happy to assist you.

 

Medical, Behavioral Health and Long-Term Care Services
Customer Call Center

Available 8:00 a.m. to 5:00 p.m.,
Monday through Friday
Customer Call Center: 877‐236‐0826
Customer Call Center TTY: 711

Provider Call Center (Effective 1/1/2014) 
Phone: 888-702-2202

Main Office Address
8220 San Pedro NE, Suite 300
Albuquerque, NM 87113

Credentialing
Medical: 888-702-2202
Behavioral Health: 877-614-0484

Pharmacy
Optum RX
Phone: 800‐310‐6826
Fax: 866‐940‐7328

Transportation
Logisticare (non‐emergent, medically necessary)
Reservations: 866‐913‐2492
Ride Assistance: 866‐913‐2493
Recurring Appointments: 866‐400‐8233
TTY: 866‐288‐3133

Dental
United Dental Benefits
Phone: 877‐408‐0159

Vision
March Vision
Phone: 888-493-4070 (providers only)

 

Prior Authorization Archive

Click the arrow to view prior authorizations from 2017 and earlier.

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 NM - Effective 1/1/2017 (PDF 238.36 KB)

UnitedHealthcare Community Plan Prior Authorization NM - Effective 10/1/2016 (PDF 238.96 KB)

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

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

UnitedHealthcare Community Plan Prior Authorization NM - Effective 7/1/2016 (PDF 199.55 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 List NM - Effective 5/1/2016 (PDF 187.86 KB)

UnitedHealthcare Community Prior Authorization - NM - Effective 1/1/2016 (PDF 171.82 KB)

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

UnitedHealthcare Community Prior Authorization List - Effective 12/7/2015 (PDF 186.2 KB)

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

Advance Notification Requirements for New Mexico - Effective 6/1/2015 (PDF 188.16 KB)

Advance Notification Requirements for New Mexico - Effective 4/1/2015 (PDF 171.86 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.

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

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.

 

HIPAA Claim Edits 

UnitedHealthcare applies HIPAA edits to professional (837p) and Institutional (837i) claims submitted electronically. Visit the EDI Claim Edits page for more information including a complete list of edits, edits related to ICD-10 codes and applicable payers.

Claims that reject for HIPAA edits will appear on a clearinghouse level report, enabling you to Identify and correct rejected Information prior to UnitedHealthcare receiving the claim.

 

 

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.