UnitedHealthcare Community Plan
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UnitedHealthcare Community Plan New York 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 Us

Click on the arrow above to view contact information. 

Provider Call Center

866-362-3368


 

Postal Mailing Address

UnitedHealthcare Community Plan
77 Water Street, 14th Floor
New York, NY 10005

Claims Mailing Address

UnitedHealthcare Community Plan
PO Box 5240
Kingston, NY 12402-5240

Utilization Management Appeals Address   

UnitedHealthcare Community Plan
PO Box 31364
Salt Lake City, UT 84131-0364
Fax: (801) 994-1082

Claims Appeals Mailing Address

Part C Appeals or Grievances:
UnitedHealthcare Community Plan
Attn: Complaint and Appeals Department
P.O. Box 31364
Salt Lake City, UT 84131-0364
Fax: (801) 994-1082

 

Medicare Part D Grievances:
UnitedHealthcare Community Plan
Attn: Complaint and Appeals Department
P.O. Box 31364
Salt Lake City, UT 84131
Fax: (801) 994-1082

Medicare Part D Appeals:
UnitedHealthcare Community Plan
Attn: Part D Standard Appeals
P.O. Box 6103
Cypress, CA 90630-9998
Fax: (877) 960-8235

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

 

Provider Resources

Access and Availability Standards (PDF 71.48 KB)
New York Physician, Health Care Professional, Facility and Ancillary Administrative Guide
(PDF 6.82 MB)
New York Administrative Guide Supplement
(PDF 51.94 KB)
UnitedHealthcare Community Plan Added to Electronic Payments & Statements
(PDF 59.89 KB)
UnitedHealthcare Community Plan Essential Plan Information Sheet
(PDF 197.7 KB)

UnitedHealthcare Community Plan for Families

Prior Authorization Fax Request Form  (PDF 115.21 KB)
Addendum A (PDF 15.57 KB)

UnitedHealthcare Community Plan for Kids

Prior Authorization Fax Request Form (PDF 115.21 KB)
 Addendum A
(PDF 15.57 KB)

Downloadable Directories

These directories list the names and addresses of health care professionals and facilities within this health plan. Each directory can be printed or saved to your computer.

Upstate New York (PDF 4.69 MB)
Upstate New York (Rockland and Westchester) (PDF 3.65 MB)
Upstate New York (Broome, Chenango, Clinton, Jefferson, Tioga and Warren) (PDF 2.74 MB)
Downstate New York (PDF 7.93 MB)
Downstate (Manhattan and Bronx) (PDF 6.89 MB)
Downstate (Kings and Richmond) (PDF 6.24 MB)
Personal Care Services Supplemental Directory (PDF 240.66 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 Injectables

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.

Prior Authorization Archive

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

UnitedHealthcare Community Plan Prior Authorization NY - Effective 4/1/2017 (PDF 235 KB)

UnitedHealthcare Medicare Solutions and UnitedHealthcare Community Plan-Medicare Notification/Prior Authorization Requirements - Effective 5/1/2017 (PDF 299.55 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 NY - Effective 1/1/2017 (PDF 224.57 KB)

UnitedHealthcare Community Plan Prior Authorization NY - Effective 10/1/2016 (PDF 226.25 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 NY - Effective 7/1/2016 (PDF 205.74 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 List NY - Effective 5/1/2016 (PDF 216.31 KB)

UnitedHealthcare Community Plan Prior Authorization NY - Effective 1/1/2016 (PDF 220.19 KB)

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

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

UnitedHealthcare Community Plan Prior Authorization List - Effective 12/7/2015 (PDF 230.1 KB)

Advanced Notification Requirements for New York - Effective 6/1/2015 (PDF 224.27 KB)

Advanced Notification Requirements for New York - Effective 10/1/ 2014 (PDF 247.1 KB)

CPT (Current Procedural Terminology) Codes

Radiology Crosswalk Table (PDF 934.25 KB)
Radiology Prior Authorization List - Medicaid (PDF 304.09 KB)
Radiology Prior Authorization List - Dual Advantage (PDF 301.61 KB)

 

 

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.