Dual Complete (RPPO-SNP) Program
Effective January 1, 2018, UnitedHealthcare Community Plan of North Carolina launches a new Dual Special Needs Plan (DSNP) – UnitedHealthcare Dual Complete (RPPO-SNP), a State wide Medicare Advantage program.
This is a Medicare Advantage plan for members who qualify for both Medicare and Medicaid. DSNPs are a specialized type of Medicare Advantage Prescription Drug Plan (MAPD) and must follow existing Centers for Medicare & Medicaid Services (CMS) rules. DSNPs must:
Adhere to required MAPD benefits
Limit enrollment to Medicaid recipients (dually eligible – Medicare and Medicaid),
Provide Part D benefits, and
Offer targeted clinical programs, benefits, and services.
This web page is dedicated to information specific to the Dual Complete Medicare Advantage program. Look here for provider resources including the Administrative Guide, quick reference guide, provider directory, policies and news related to the Dual Compete Medicare Advantage program.
Prior Authorization
UnitedHealthcare Medicare Prior Authorization Requirements Effective 4/1/2018 (PDF 293.21 KB) - 4.2.2018
Resources
Dual Complete Medicare Advantage Pharmacy Formulary
Dual Complete Mental Health Directory
Search for a Care Provider – Dual Complete Medicare Advantage Provider Directory
UHC On Air (PDF 263.27 KB)
Documents
Dual Complete Administrative Guide
Dual Complete Medicare Advantage Quick Reference Guide (PDF 156.75 KB)
Dual Complete Medicare Advantage Frequently Asked Questions (PDF 76.89 KB)
Understanding North Carolina Dual Complete Medicare Advantage
(PDF 195.64 KB)
Coverage Summaries and Reimbursement Policies
UnitedHealthcare Medicare Advantage Coverage Summaries
UnitedHealthcare Medicare Advantage Reimbursement Policies
Additional Medicare Advantage Policies
Medicare Advantage Prior Authorization Protocols
Link and UHCProvider.com
Use Link to perform secure transactions such as checking member eligibility and benefits, managing claims and requesting prior authorization.
To sign in to Link, go to UHCprovider.com and click on the Link button in the top right corner. If you don’t aren’t registered yet, go to UHCprovider.com and select “New User” to begin registration.
To learn more about using Link, please visit UHCprovider.com/Link.