UnitedHealthcare Community Plan
You appear to be browsing this site using Internet Explorer 6. This browser is now out of date. For safer, more reliable browsing it is recommended that you upgrade your browser to Firefox, Safari or Internet Explorer 7 or 8.
Shortcut Navigation:

What can we do to make the UnitedHealthcare Provider Manuals better for you? Click here to provide feedback.

Please select the state where you practice.

Welcome to the UnitedHealthcare Community Plan Health Professionals area for Pennsylvania providers.

Here, you will find the information and links you need to conduct business with UHC Community Plan. Choose your topic of interest by selecting one of the left navigation buttons.

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

Contact Us

Click on the arrow above to view contact information. 

Provider Call Center

800-600-9007
Monday-Friday, 8 a.m. – 5 p.m. 

Postal Mailing Address

UnitedHealthcare Community Plan
2 Allegheny Center Suite 600
Pittsburgh, PA 15212 

Claims Mailing Address

UnitedHealthcare Community Plan
PO Box 8207
Kingston, NY 12402-8207

Utilization Management Appeals Address   

UnitedHealthcare Community Plan
Attn: Grievances and Appeals
PO Box 31364
Salt Lake City, UT 84131-0364

Claims Appeals Mailing Address

Part C Appeals and Grievance Department
UnitedHealthcare Community Plan
Attn: Complaint and Appeals Department
P.O. Box 31364
Salt Lake City, UT 84131-0364

 

Part D Appeals and Grievance Department
Attn: CA124-0197
P.O. Box 6106
Cypress, CA 90630-9948


 
Prior Authorization Archive

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

UnitedHealthcare Community Plan Prior Authorization PA CHIP - Effective 1/1/2017 (PDF 233.97 KB)

UnitedHealthcare Community Plan Prior Authorization PA CAID - Effective 1/1/2017 (PDF 215 KB)

UnitedHealthcare Community Plan Prior Authorization PA CHIP - Effective 10/1/2016 (PDF 231 KB)

UnitedHealthcare Community Plan Prior Authorization PA CAID - Effective 10/1/2016 (PDF 209.76 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 PA CAID - Effective 7/1/2016 (PDF 210.33 KB)

UnitedHealthcare Community Plan Prior Authorization PA CHIP - Effective 7/1/2016 (PDF 210.81 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 PA - Effective 5/1/2016 (PDF 213.32 KB)

UnitedHealthcare Community Plan Prior Authorization PA - Effective 1/1/2016 (PDF 225.41 KB)

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

UnitedHealthcare Community Plan Prior Authorization List - Effective 12/7/2015 (PDF 228.04 KB)

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

Advance Notification Requirements for Pennsylvania - Effective 6/1/2015 (PDF 226.15 KB)

Advance Notification Requirements for Pennsylvania - Effective 10/1/2014 (PDF 267.44 KB)

 

Provider Administrative Manual

Physician, Health Care Professional, Facility and Ancillary Provider Manual (PDF 2.64 MB)

 

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. 

View the clinical criteria and guidelines used to conduct medical necessity reviews.

Medical Injectables Information

Click on the arrow above for 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.

 

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.