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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

Florida Pre-Service Reconsideration Request Form (PDF 35.2 KB)

Florida Pre-Service Reconsideration Process – Effective Nov. 1, 2017 (PDF 45.34 KB)

UnitedHealthcare Medicare Solutions & UnitedHealthcare Community Plan

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

UnitedHealthcare Community Plan - Florida 

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)

Site of Service for Outpatient Surgical Procedures FAQ - Effective 12/1/15 (PDF 251.42 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 Community Plan Prior Authorization - Effective 12/7/2015 (PDF 173.01 KB)

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

Advance Notification Requirements for Florida, Effective 6/1/2015 (PDF 173.6 KB)

Advance Notification Requirements for Florida, Effective 3/1/2015 (PDF 467.44 KB)

 

Mga Medikal na Injectable

Ang mga gamot sa specialty na botika na saklaw sa Medikal na Pakinabang ay maaaring ibigay sa pamamagitan ng iba't ibang channel – home infusion provider, pasilidad ng outpatient, manggagamot o specialty na botika.

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

BriovaRx

855-427-4682

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

Gaucher's Disease

Immune Globulin

Pulmonary Hypertension

800-803-2523

 

Option Care (nursing services)

Kakulangan sa Enzyme

Gaucher's Disease

Hemophilia

Immune Globulin

Makena

866-827-8203

Specialty na Botika ng CVS Caremark

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. 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).

Disclaimer

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.