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. 

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

Clinical Practice Guidelines Update

The 2015 Clinical Practice Guidelines update web links were approved by the CMO on June 16, 2015.The complete document, including a summary of additions and revisions were posted to the website on June 16, 2015.  Click here (PDF 220.65 KB) to view the guidelines.

Provider Manual

Physician, Health Care Professional,Facility and Ancillary Provider Manual (PDF 2.39 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.

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.


Fostering Positive Youth Development: Opportunities to Reframe the Conversation About Trauma
April 1, 2016, 10:00–11:00 a.m. How might we create school systems and services that engage young people to improve their experience of school climate and wellness? This webinar will explore frameworks and approaches for developing effective youth leadership and positive school climate in your school community, unpacking how and why youth voice is essential to building healthy school climates and cultures. Specific challenges with youth engagement will be discussed.

Self and Collective Care of Youth-Serving Adults
April 8, 2016, 10:00–11:00 a.m. Students are at the center of our work. At the same time, adults in our school communities need support in order to show up for the young people they serve. This webinar will explore how we can create cultures of care not only for youth, but also for the adults who work with them. 


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.