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Member Health Waivers 

If you are a provider of a member whose health was previously cared for under one of the following waivers, please contact Provider Services for extra help understanding your full benefit program:

  • Project Aids Care (PAC) Waiver
  • Traumatic Brain Injury (TBI) or Spinal Cord Injury (SCI) Waiver
  • Adult Cystic Fibrosis (ACF) Waiver

You can reach our Provider Services team by calling the number on the back of your members ID card, or by referencing the contact numbers below:

Managed Medical Assistance (MMA): 877-842-3210
Long Term Care (LTC): 800-791-9233

 

Prior Authorization

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 - Florida

UnitedHealthcare Community Plan Prior Authorization FL - Effective 7/1/2018 (PDF 579.33 KB)

 

UnitedHealthcare Community Plan Prior Authorization FL - Effective 4/1/2018 (PDF 197.07 KB)

UnitedHealthcare Medicare Prior Authorization Requirements - Effective 1/1/2018 (PDF 282.37 KB)

UnitedHealthcare Community Plan Prior Authorization FL - Effective 1/1/2018 (PDF 238.19 KB)

UnitedHealthcare Medicare Prior Authorization Requirements - Effective 10/1/2017 (PDF 286.74 KB)

UnitedHealthcare Community Plan Prior Authorization FL - Effective 10/1/2017 (PDF 241.15 KB)

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

UnitedHealthcare Community Plan Prior Authorization FL - Effective 9/1/2017 (PDF 234.83 KB)

UnitedHealthcare Community Plan Prior Authorization FL - Effective 7/1/2017 (PDF 221.33 KB)

UnitedHealthcare Community Plan Prior Authorization FL - Effective 6/1/2017 (PDF 221.31 KB)

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

UnitedHealthcare Community Plan Prior Authorization FL - Effective 4/1/2017 (PDF 218.33 KB)

UnitedHealthcare Medicare Solutions and UnitedHealthcare Community Plan-Medicare Notification/Prior Authorization Requirements - Effective 1/1/2017 (PDF 306.96 KB)

UnitedHealthcare Medicare Solutions and UnitedHealthcare Community Plan-Medicare Notification/Prior Authorization Requirements - Effective 4/1/2017 (PDF 300.79 KB)

UnitedHealthcare Community Plan Prior Authorization FL - Effective 2/1/2017 (PDF 214.63 KB)

UnitedHealthcare Community Plan Prior Authorization FL - Effective 1/1/2017 (PDF 211.49 KB)

UnitedHealthcare Community Plan Prior Authorization FL - Effective 10/1/2016 (PDF 213.96 KB)

UnitedHealthcare Medicare Solutions and UnitedHealthcare Community Plan Notification / Prior Authorization Requirements -  Effective 10/1/2016 (PDF 277.31 KB)

UnitedHealthcare Community Plan Prior Authorization FL - Effective 10/1/2016 (PDF 213.96 KB)

UnitedHealthcare Community Plan Prior Authorization FL Effective 7/1/2016 (PDF 195.49 KB)

UnitedHealthcare Medicare Solutions and UnitedHealthcare Community Plan Notification/Prior Authorization Requirements Effective 7/1/2016 (PDF 266.74 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 FL - Effective 5/1/2016 (PDF 197.68 KB)

UnitedHealthcare Medicare Solutions Notification/Prior Authorization List - Effective 1/1/16

(PDF 250.02 KB)UnitedHealthcare Medicare Solutions Notification/Prior Authorization List - Effective 1/1/16 (PDF 249.77 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.

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.

 

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).

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.