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UnitedHealthcare Community Plan Hawaii Providers

Aloha and welcome to UnitedHealthcare Community Plan!

Dito, makikita mo ang impormasyon at mga link na kailangan mo upang maisagawa ang gagawin sa Planong Pangkomunidad ng UHC.  Pakipili ang paksa ng iyong interes, sa pamamagitan ng pagpili sa isa sa mga button sa pag-navigate sa kaliwang banda ng pahina, o pumili ng isa sa mga paksa o produkto sa ibaba upang tingnan ang mga detalye.

Contact Us - QUEST Integration (PDF 75.12 KB)

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

 

HIPAA Claim Edits

UnitedHealthcare applies HIPAA edits to professional (837p) and Institutional (837i) claims submitted electronically. Visit the EDI Claim Edits page for more information including a complete list of edits, edits related to ICD-10 codes and applicable payers. Claims that reject for HIPAA edits will appear on a clearinghouse level report, enabling you to Identify and correct rejected Information prior to UnitedHealthcare receiving the claim.

 

Mga Pagbabago at Update sa Paghahatid ng Serbisyo

Ang anumang mga pagbabago o update sa paghahatid ng serbisyo ay ipaparating sa pamamagitan ng portal na ito sa ilalim ng Seksyon na "Mga Pagbabago at Update sa Paghahatid ng Serbisyo," Mga Newsletter o Bulletin ng Provider, Pagtuturo sa Provider at Mga Sesyon ng Pagsasanay at iba pang mga anyo ng pakikipag-ugnayan.  

 

 

Prior Authorization

QUEST Integration Prior Authorization Request Form (PDF 296.87 KB)

HI Medicare DSNP Prior Authorization Request Form (PDF 577.61 KB)

Planong Pangkomunidad ng UnitedHealthcare
UnitedHealthcare Community Plan Prior Authorization HI - Effective 10/1/2017 (PDF 195.47 KB)

UnitedHealthcare Medicare Solutions and United Healthcare Community Plan
UnitedHealthcare Medicare Prior Authorization Requirements - Effective 10/1/2017 (PDF 286.74 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 HI - Effective 7/1/2017 (PDF 194.84 KB)

UnitedHealthcare Community Plan Prior Authorization HI - Effective 4/1/2017 (PDF 192.85 KB)

UnitedHealthcare Medicare Solutions and UnitedHealthcare Community Plan-Medicare Notification/Prior Authorization Requirements - Effective 5/1/2017 (PDF 299.55 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 HI - Effective 1/1/2017 (PDF 190.49 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 HI - Effective 10/1/2016 (PDF 195.36 KB)

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

UnitedHealthcare Community Plan Prior Authorization HI - Effective 7/1/2016 (PDF 193.19 KB)

UnitedHealthcare Medicare Solutions and UnitedHealthcare Community Plan Notification/Prior Authorization Requirements - Effective 5/1/2016 (PDF 251.42 KB)

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

Advanced Notification Requirements for HI - Effective Jan. 15, 2015 (PDF 489.67 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 one of the following network specialty pharmacies:

Specialty na Botika ng Network

Numero ng Telepono

BriovaRx

866-815-5338

BioScrip (nag-aalok ng mga serbisyo sa pangangalaga)

• also serves as a national home infusion provider for medical benefit medications

866-788-7710

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)

Cardiovascular/Hindi Maayos na Paggana ng Puso

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.