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.

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.

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


Note: UnitedHealthcare Community Plan's Portal will be a historic portal only and will display claims and eligibility for dates of services prior to 3/1/14. If you are looking for details on Member Eligibility or Claim Status for dates of service on or after 3/1/14, please use UnitedHealthcare Online. If you do not already have access to UnitedHealthcare Online, you will need to register as a new user.

Thank you for being a valued partner of UnitedHealthcare Community Plan.

Please choose your topic of interest, by selecting one of the navigation buttons on the left-hand side of the page, or select one of the topics or products below to reveal our Contact Information, Provider Administrative Manuals and Forms.

Contact Us

Provider Call Center

Monday-Friday, 8 a.m. – 5 p.m. 

Postal Mailing Address

UnitedHealthcare Community Plan
1001 Brinton Road
Pittsburgh, PA 15221

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



The 2015 Clinical Practice Guidelines were updated on May 7, 2015 by the Medical Technology Assessment Committee and approved by the Community Plan of Pennsylvania's Provider Advisory Committee on June 18, 2015.

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 it through a network specialty pharmacy:

Network Specialty Pharmacy

Phone Number



BioScrip (offers nursing services)

• also a National Home Infusion Provider for Medical Benefit medications


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



Option Care (offers nursing services)

Cardiovascular/Heart Failure

Enzyme Deficiency

Gaucher's Disease


Immune Globulin



CVS Caremark Specialty Pharmacy

Enzyme Deficiency

Gaucher's Disease


Pulmonary Hypertension


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 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.


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.