UnitedHealthcare Community Plan
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UnitedHealthcare Community Plan New York Providers

Contact Us

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


 

Medicare Part D Appeals:
UnitedHealthcare Community Plan
Attn: Part D Standard Appeals
P.O. Box 6103
Cypress, CA 90630-9948
Fax: (877) 960-8235

UnitedHealthcare Community Plan for Families
UnitedHealthcare Community Plan for Kids

CPT (Current Procedural Terminology) Codes
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.

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.

 

Clinical Practice Guidelines Update

The UHC Clinical Practice Guidelines have been updated and approved by the following:

Medical Technology Assessment Committee Approval Status – May 7, 2015

Provider Advisory Committee Approval – June 4, 2015

The complete document, including a summary of additions and revisions can be found here. (PDF 220.65 KB)

 

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.

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.