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UnitedHealthcare Community Plan Arizona 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.

Providers are encouraged to check our website frequently for updates regarding reimbursement policies, provider manuals and bulletins, providing information to our provider network of changes throughout the year.  

Provider Call Center: 800-445-1638
Hours of Operation: 8:00 am-5:00 pm CST

Mailing Address:
UnitedHealthcare Community Plan
1 East Washington, Suite 900
Phoenix, AZ 85004

Claims & Medical Records Mailing Address:
UnitedHealthcare Community Plan
PO Box 5290
Kingston, NY 12402-5290

Member Appeals & Provider Claim Disputes Mailing Address
UnitedHealthcare Community Plan
Attn: Appeals & Claim Disputes
1 East Washington, Suite 900
Phoenix, AZ 85004

Behavioral Health Claims & Medical Records Mailing Address:
United Behavioral Health
PO Box 30760
Salt Lake City, UT 84130-0760

 

Member Appeals & Provider Claim Disputes Mailing Address
UnitedHealthcare Community Plan
Attn: Complaint and Appeals Department
1 East Washington, Suite 900
Phoenix, AZ 85004

Mailing Address:
UnitedHealthcare Community Plan
1 East Washington, Suite 900
Phoenix, AZ 85004

Claims & Medical Records Mailing Address:
UnitedHealthcare Community Plan
PO Box 5290
Kingston, NY 12402-5290

Behavioral Health Claims & Medical Records Mailing Address:
United Behavioral Health
PO Box 30760
Salt Lake City, UT 84130-0760

AHCCCS Dental Provider Benefits Matrix (PDF 417.91 KB) - Provides information needed to properly document dental benefits provided through UnitedHealthcare Community Plan.

We encourage our medical professionals and their staff to review the Fraud and Abuse information available on the AHCCCS website. The comprehensive guide discusses your responsibilities as a provider for  Fraud and Abuse.

View the Fraud and Waste guide

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

HIPAA Information (PDF 56.24 KB)

Long Term Care Provider Call Center: 1-800-293-3740

Hours of Operation: 8:00 am- 5:00 pm Arizona Time

Mailing Address:
UnitedHealthcare Community Plan
1 East Washington, Suite 900
Phoenix, AZ 85004

Claims & Medical Records Mailing Address for Dates of Service before April 1, 2016
UnitedHealthcare Community Plan
P. O. Box 30995
Salt Lake City, UT 84130

Claims & Medical Records Mailing Address for Dates of Service on/after April 1, 2016
UnitedHealthcare Community Plan
P.O. Box 5290
Kingston, NY 12402-5290

Member Appeals & Provider Claim Disputes Mailing Address
UnitedHealthcare Community Plan
Long Term Care Claims
Attn: Provider Claim Dispute Coordinator
1 E. Washington Street, Suite 900
Phoenix, AZ 85004

Behavioral Health Claims & Medical Records Mailing Address:
United Behavioral Health
PO Box 30760
Salt Lake City, UT 84130-0760

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 the following network specialty pharmacy:

Network Specialty Pharmacy

Phone Number

BriovaRx

855-427-4682

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)

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.

CRS Behavioral Health Out-of-Home Request (PDF 74.04 KB)

UnitedHealthcare Medicare Solutions & UnitedHealthcare Community Plan (Dual Special Needs Plan)

View current UnitedHealthcare Medicare Solutions & UnitedHealthcare Community Plan (Dual Special Needs Plan) Prior Authorization Requirements on UHCprovider.com

UnitedHealthcare Community Plan - Acute Medicaid
UnitedHealthcare Community Plan Prior Authorization AZ Acute - Effective 7/1/2018 (PDF 544.82 KB)

UnitedHealthcare Community Plan - Children's Rehabilitative Services
UnitedHealthcare Community Plan Prior Authorization AZ CRS - Effective 7/1/2018 (PDF 623.87 KB)

UnitedHealthcare Community Plan - Developmentally Disabled
UnitedHealthcare Community Plan Prior Authorization AZ DD - Effective 7/1/2018 (PDF 548.78 KB)

UnitedHealthcare Community Plan - Long Term Care
UnitedHealthcare Community Plan Prior Authorization AZ LTC - Effective 7/1/2018 (PDF 600.66 KB)

UnitedHealthcare Community Plan Prior Authorization AZ Acute - Effective 4/1/2018 (PDF 291.5 KB)

UnitedHealthcare Community Plan Prior Authorization AZ CRS - Effective 4/1/2018 (PDF 367.44 KB)

UnitedHealthcare Community Plan Prior Authorization AZ DD - Effective 4/1/2018 (PDF 294.3 KB)

UnitedHealthcare Community Plan Prior Authorization AZ LTC - Effective 4/1/2018 (PDF 266.12 KB) 

UnitedHealthcare Community Plan Prior Authorization AZ Acute - Effective 1/1/2018 (PDF 298.94 KB)

UnitedHealthcare Community Plan Prior Authorization AZ CRS - Effective 1/1/2018 (PDF 377.9 KB)

UnitedHealthcare Community Plan Prior Authorization AZ DD - Effective 1/1/2018 (PDF 301.07 KB)

UnitedHealthcare Community Plan Prior Authorization AZ LTC - Effective 1/1/2018 (PDF 143.05 KB)

UnitedHealthcare Medicare and UnitedHealthcare Community Plan (Dual Special Needs Plan) Prior Authorization Requirements - Effective 1/1/2018  (PDF 282.37 KB)

UnitedHealthcare Medicare and UnitedHealthcare Community Plan (Dual Special Needs Plan) Prior Authorization Requirements - Effective 10/1/2017 (PDF 286.74 KB)

UnitedHealthcare Community Plan Prior Authorization AZ Acute - Effective 10/1/2017 (PDF 310.45 KB)

UnitedHealthcare Community Plan Prior Authorization AZ CRS - Effective 10/1/2017 (PDF 382.32 KB)

UnitedHealthcare Community Plan Prior Authorization AZ DD - Effective 10/1/2017 (PDF 306.88 KB)

UnitedHealthcare Community Plan Prior Authorization AZ LTC - Effective 10/1/2017 (PDF 269.52 KB)

UnitedHealthcare Medicare Solutions and UnitedHealthcare Community Plan (Dual Special Needs Plan) Prior Authorization Requirements - Effective 7/1/2017 (PDF 300.09 KB)

UnitedHealthcare Community Plan Prior Authorization AZ Acute - Effective 7/1/2017 (PDF 302.58 KB)

UnitedHealthcare Community Plan Prior Authorization AZ CRS - Effective 7/1/2017 (PDF 372.08 KB)

UnitedHealthcare Community Plan Prior Authorization AZ DD - Effective 7/1/2017 (PDF 297.21 KB)

UnitedHealthcare Community Plan Prior Authorization AZ LTC - Effective 7/1/2017 (PDF 268.66 KB)

UnitedHealthcare Medicare Solutions and UnitedHealthcare Community Plan (Dual Special Needs Plan) Prior Authorization Requirements - Effective 5/1/2017  (PDF 299.55 KB)

2017 Annual Provider Satisfaction Survery Results (PDF 58.15 KB)

(AHCCCS) Arizona Health Care Cost Containment System - AHCCCS is Arizona's Medicaid program, designed to deliver quality health care under cutting-edge concepts of managed care. Over the years, independent evaluations repeatedly have praised the program's effectiveness. AHCCCS has received national acclaim as a model for other Medicaid programs.

(AHCCCS) Performance Measures - Performance Measures as defined by Arizona Health Care Cost Containment System.

AHCCCS Chapter 10 FQHC / RHC Addendum

Arizona Department of Health Services - Arizona Department of Health Services web site has comprehensive list of services provided.

Best Available Evidence - The Best Available Evidence policy requires Medicare Part D sponsors to establish the appropriate cost-sharing for low-income beneficiaries when presented with evidence that the beneficiary's information is not accurate.

Claims and Payments - Research and remits for claims and claims status.

Centers for Medicare and Medicaid Services (CMS) - The Centers for Medicare & Medicaid Services is a Federal agency within the U.S. Department of Health and Human Services. Programs for which CMS is responsible include Medicare, Medicaid, State Children's Health Insurance Program (SCHIP), HIPAA, and CLIA.

Children's Rehabilitative Services - Office for Children with Special Health Care Needs web site shows how to improve the quality of life for children by providing family-centered medical treatment, rehabilitation, and related support services.

Clinician Resources - The UnitedHealth Premium physician designation program uses clinical information from health care claims to assist physicians in their continuous practice improvement and to help consumers make more informed and personally appropriate choices for their medical care.

Children's Rehanilitative Services (CRS) Behavioral Health - For CRS Behavioral Health eligibility & benefits, authorizations, claim status, demographics updates, or Behavioral Network Services contact information.

Dental Provider Benefits Matrix for UnitedHealthcare Community Plan Members (PDF 144.24 KB) - Dental services are limited to members under age 21 except for a limited set of services as indicated on the matrix.

Department of Health & Human Services - U.S. Department of Health & Human Services official website.

Early and Periodic Screening Diagnosis and Treatment Tracking Forms (EPSDT) - Appendix B of the AHCCCS Medical Policy Manual contains several Early and Periodic Screening Diagnosis and Treatment Tracking Forms for specific time periods. 

Health Information Portability and Accountability Act (HIPAA) - HIPAA information for professionals regarding privacy, security, transactions and code sets, and national identifiers resource on regulations and compliance for the healthcare industry.

Healthfinder - Healthfinder has been recognized as a key resource for finding the best government and nonprofit health and human services information on the Internet. Healthfinder links to carefully selected information from over 1,700 health-related organizations.

Immunization Schedules - Recommended immunization schedules from the Centers for Disease Control and Prevention (CDC) for children, adolescents and adults.

Low-Cost/No-Cost Clinic Resources in Arizona - Sliding Fee Schedule (SFS) clinics throughout Arizona that provide free or low cost primary, mental and dental health services to persons without health insurance.

medicare.gov - The official U.S. government website for people with Medicare coverage.

Medical Policies - UnitedHealthcare Community Plan medical policies are available to you as a general reference resource.

When these medical policies are used to determine medical necessity, clinical guidelines will be applied in the following order: 1) AHCCCS Medical Policy Manual (AMPM) as it is updated; 2) UnitedHealthcare guidelines; and 3) "Milliman" guidelines.

Notifications and Prior Authorization - Electronic notifications, prior authorization requests and referral requests.

Optum Health Education (06.08.2018) - Optum Health Education offers on-demand webcasts and information regarding upcoming conferences for both physical and behavioral health providers. Some activities include Disease Management, Autism Spectrum Disorder, Behavioral Health, Intellectual and Developmental Disabilities

Pediatric Care Guidelines - The American Academy of Pediatrics is an organization of 66​,000 pediatricians committed to the optimal physical, mental, and social health and well-being for all infants, children, adolescents, and young adults.​

The Society for Post-Acute and Long-Term Care Medicine (formerly American Medical Directors Association) - Organization dedicated to excellence in patient care and provides education, advocacy, information, and professional development to promote the delivery of quality long term care medicine. 

Verifying Member Eligibility through AHCCCS Online (06.08.2018) - How to register and access AHCCCS member eligibility information.

AHCCCS Dental Provider Benefits Matrix (PDF 417.91 KB) - Provides information needed to properly document dental benefits provided through UnitedHealthcare Community Plan. Date posted 10.01.2017.

Behavioral Health Toolkit for Medical Providers - The Behavioral Health toolkit includes assessment tools, screening tools, behavioral health guidelines, identifying in-network referrals and health information for patients. Date posted 06.08.0218.

Medical Record Documentation Requirements (PDF 41.3 KB) - Guidelines for physicians to ensure that a medical record is maintained in accordance to state guidelines. Date posted 01.19.2018.

Trauma-Informed Care and Services (On-Demand Education) (PDF 606.23 KB) - A three-part educational series for physicians, nurses, behavioral health clinicians and therapists, social workers (all practice types), peer support specialists, foster parents, residential placement staff and others who have an interest in topics relevant to child welfare. Date posted 02.01.2016.

Member Appeals & Provider Claim Disputes Mailing Address
UnitedHealthcare Dual Complete
Attn: Appeals
PO Box 31364
Salt Lake City, UT 84131-0364

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

Mailing Address:
UnitedHealthcare Community Plan
1 East Washington, Suite 900
Phoenix, AZ 85004

Claims & Medical Records Mailing Address:
UnitedHealthcare Community Plan
PO Box 5290
Kingston, NY 12402-5290

Behavioral Health Claims & Medical Records Mailing Address:
United Behavioral Health
PO Box 30760
Salt Lake City, UT 84130-0760

 

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).

2014 UnitedHealthcare Community Plan Physician Satisfaction Results (PDF 76.97 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.