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As of January 1st, 2018 UnitedHealthcare Community Plan will no longer provide Medicaid and Long Term Care coverage in Delaware. For questions about 2018 services, members can call their new Health Plan Member Service’s phone number, it is on their ID card. If members have questions related to any services prior to January 1, 2018, members can call United Healthcare Community Plan member services at 1-877-877-8159.
This change doesn’t affect UnitedHealthcare Medicare, including Institutional Special Needs Plan (I-SNP) and Dual Complete Plan (DSNP) or UnitedHealthcare Commercial Plan members.
Healthcare Providers can continue to call Provider Services at 1-800-600-9007. For questions regarding behavioral health, please call 1-877-614-0484. For questions regarding Dental, please call 1-855-609-5152.
- Impormasyon ng Provider
- Behavioral Health Resources
- Mga Bulletin
- Muling Pagsasaalang-alang ng Paghahabol at Mga Apela
- Mga Claim at Impormasyon ng Miyembro
- Mga Alituntunin sa Mga Gawain sa Klinika
- Cultural Competency Library
- Dual Complete (HMO SNP) Program
- Electronic Data Interchange (EDI)
- Mga Materyal sa Pagtuturo sa Bahagi D ng Medicare
- Mga Newsletter
- Programa sa Botika
- Patakaran sa Pag-reimburse
Welcome to the UnitedHealthcare Community Plan Health Professionals area for Delaware providers!
Here you will find the information, forms, manuals and links you need to conduct business with UnitedHealthcare Community Plan.
Attention Providers: Some phone numbers for UHC staff members have changed. Click "Contact Us" for the updated information.
Medicaid Managed Care Rule External FAQ’s (PDF 64.57 KB)
Medicaid Managed Care Rule Presentation (PDF 90.71 KB)
Important Phone Numbers and Websites - Contact Us (PDF 215.34 KB)
Click on the arrow above to view manuals and forms.
Provider Administrative Manuals
- Delaware Medicaid and DSHP Plus Long Term Care Provider Manual (PDF 1.63 MB)
- Quick Reference Guide for the UnitedHealthcare Administrative Guides (PDF 112.23 KB)
Form ng Pagbubunyag ng Pagmamay-ari at Pagkontrol sa Interes ng Pangkat mag-click dito (PDF 519.75 KB) para sa PDF na bersyon.
Form ng Pagbubunyag ng Pagmamay-ari at Pagkontrol sa Interes ng Indibidwal mag-click dito (PDF 427.75 KB) para sa PDF na bersyon.
- Gaucher's Disease Enzyme Therapy Prior Authorization Form (PDF 230.11 KB)
- Abortion Justification Form (PDF 64.27 KB)
- Behavioral Health Conversion of Benefits (PDF 71.92 KB)
- Member Education Request (PDF 142.27 KB)
- Obstetrical Needs Assessment (PDF 33.54 KB)
- Prior Authorization Fax Request Form (PDF 183.29 KB)
- Sleep Study Worksheet (PDF 192.95 KB)
- Sterilization - Awareness (PDF 82.57 KB)
- Sterilization - Consent (PDF 227.56 KB)
- UBH Provider
- Botulinum Toxins Prior Authorization Form (PDF 510.97 KB)
- HP Acthar Gel Prior Authorization Form (PDF 225.65 KB)
- Immune Globulin Prior Authorization Form (PDF 230.5 KB)
- Makena Prior Authorization Form (PDF 227.5 KB)
- Xolair Prior Authorization Form (PDF 510.06 KB)
Click on the arrow above to view provider educational materials.
Asthma Triggers (PDF 96.83 KB)
Blood Sugar (PDF 159.13 KB)
Care Providers and Quality Measures (PPTX 800.04 KB)
Hemoglobin A1c (PDF 178.36 KB)
Branding Article July 2011 (PDF 60.9 KB)
Disease Management Information (PDF 135.11 KB)
Electronic Tools & Resources for Home and Community Based Services (HCBS) and Long-Term Support Services (LTSS) Providers (PDF 62.2 KB)
Healthy First Steps (PDF 1.76 MB)
Online Prior Authorization Request Tool Instructions (PDF 115.98 KB)
Provider Portal Application Authorization Status Inquiry Instruction Sheet (PDF 179.5 KB)
Transportation Benefits (PDF 20.41 KB)
United Behavioral Health FAQ (PDF 184.12 KB)
Rebranding Bulletin (PDF 131.6 KB)
EDI Fact Sheet (PDF 1.53 MB)
ERA and EFT Fact Sheet (PDF 660.45 KB)
Getting Connected with EDI, EFT and ERA (PDF 147.57 KB)
Click on the arrow above to view information on medical injectables.
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:
Specialty na Botika ng Network
Numero ng Telepono
The following specialty pharmacies also provide certain types of specialty medications:
Specialty na Botika ng Network
Kategorya ng Gamot
Numero ng Telepono
Accredo (nursing services)
Kakulangan sa Enzyme
Option Care (nursing services)
Kakulangan sa Enzyme
Specialty na Botika ng CVS Caremark
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.
Click on the arrow above to view additional links and information.
- Cultural Competency https://www.thinkculturalhealth.hhs.gov/
- Medicaid Assistance Office http://www.dhss.delaware.gov/dhss/dmma/contact.html
- Advance Directives and Living Wills http://www.dhss.delaware.gov/dhss/dsaapd/advance.html
- Delaware Helpline (800) 464-HELP http://www.delaware211.org/
- Delaware Healthy Children Program http://www.dhss.delaware.gov/dss/dhcp.html
- United Behavioral Health (OptumHealth Behavioral Solutions) www.providerexpress.com
- NCQA http://www.ncqa.org/tabid/100/Default.aspx
Wellness Registry for Delaware Community Plan Providers
The Wellness Registry is a community services database that contains resources throughout the State of Delaware that can assist in meeting our member’s needs. It will help you connect members to wellness programs, such as health education and disease management classes. UniteHealthcare uses the Healthify database as the wellness registry.
To access the Wellness Registry:
- Click on the Link button at the top right of UHCprovider.com and sign in with your Optum ID
- From the Link Dashboard, navigate to the Menu at the top left and choose myData Connection Dashboard
- Then, from the myData Connection dashboard, click on the Community Resource Finder tile to access the Healthify Wellness Registry
UnitedHealthcare Community Plan received NCQA New Health Plan Accreditation on July 7, 2010. NCQA's mission is to improve the quality of health care, and participating in their accreditation process is voluntary. NCQA’s New Health Plan Accreditation Program applies to health plans that are less than 36 months old. The program is distinct from NCQA's MCO Accreditation Program. NCQA Accreditation is a nationally recognized evaluation that purchasers, regulators, and consumers can use to assess managed care plans.
Click on the arrow above to view the prior authorization archive.
Prior Authorization (PDF 221.84 KB) - Effective December 7, 2015
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. Ang mga patakaran at alituntunin na ito ay ibinibigay para sa mga layunin ng pagbibigay-impormasyon, at hindi bumubuo ng isang payong medikal.
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.
Integridad ng Mga Claim, Ulat, at Pagkakatawan sa Pamahalaan
Iniaatas ng UnitedHealth Group ang pagsunod sa mga batas pederal at batas ng estado na nagbabawal sa pagsusumite ng mga huwad na claim kaugnay sa mga pederal na programa ng pangangalaga sa kalusugan, kabilang na ang Medicare at Medicaid.
View our policy (PDF 38.15 KB).
If UHG policies conflict with provisions of a state contract or with state or federal law, the contractual / statutory / regulatory provisions shall prevail. Upang makita ang mga na-update na pagbabago sa patakaran, piliin ang seksyon ng Bulletin sa kaliwa.