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UnitedHealthcare Community Plan Ohio Providers

Welcome to the UnitedHealthcare Community Plan Health Professionals area for Ohio providers!

Here you will find the information, forms, manuals and links you need to conduct business with UnitedHealthcare Community Plan.

Attention Providers:  The Ohio Department of Medicaid has recently changed its policy on record retention per OAC 5160-26-06.  The UnitedHealthcare Community Plan Provider Agreement has changed for the retention of all records, including medical records and financial documents. 

 

Provider Call Center

 

 

(800) 600-9007
Monday-Friday, 8 a.m. – 5 p.m. 

 

Postal Mailing Address

 

 

Planong Pangkomunidad ng UnitedHealthcare
9200Worthington Road, 3rd Floor
Westerville, OH 43082

 

Claims Mailing Address

 

 

Planong Pangkomunidad ng UnitedHealthcare
P.O. Box 8207
Kingston, NY 12402

 

Utlization Management Appeals Address   

 

 

Planong Pangkomunidad ng UnitedHealthcare
Paunawa: Complaint and Appeals Department
P.O. Box 31364
Salt Lake City, UT 84131
Fax: (801) 994-1082

 

Claims Appeals Mailing Address

 

 

Planong Pangkomunidad ng UnitedHealthcare
Paunawa: Complaint and Appeals Department
P.O. Box 31364
Salt Lake City, UT 84131
Fax: (801) 994-1082

 

UHC Connected™ For MyCare
Ohio Appeals Mailing Address

 

 

Part C Appeals or Grievances:
Planong Pangkomunidad ng UnitedHealthcare
Paunawa: Complaint and Appeals Department
P.O. Box 31364
Salt Lake City, UT 84131
Fax: (801) 994-1082

Medicare Part D Grievances:
Planong Pangkomunidad ng UnitedHealthcare
Paunawa: Complaint and Appeals Department
P.O. Box 31364
Salt Lake City, UT 84131
Fax: (801) 994-1082

Medicare Part D Appeals:
Planong Pangkomunidad ng UnitedHealthcare
Paunawa: Part D Standard Appeals
P.O. Box 6103
Cypress, CA 90630-9998
Fax: (877) 960-8235

 


 

Prior Authorization

The Prior Authorization lists below are not an indication that other codes not appearing on these lists are covered. Before providing services, providers should check the following for coverage limiations and information:

UnitedHealthcare Outpatient Injectable Chemotherapy Prior Authorization Program Overview (PDF 72.17 KB)

Ohio CAID Prior Authorization Changes - Effective 4/1/2018 (XLSX 123.51 KB)

Ohio MMP Prior Authorization Changes - Effective 4/1/2018 (XLSX 110.87 KB)

 

UnitedHealthcare Medicare Solutions & UnitedHealthcare Community Plan
UnitedHealthcare Medicare Prior Authorization Requirements - Effective 1/1/2018 (PDF 282.37 KB)

Planong Pangkomunidad ng UnitedHealthcare
UnitedHealthcare Community Plan Prior Authorization OH - Effective 4/1/2018 (PDF 212.58 KB)
UnitedHealthcare Community Plan Prior Authorization OH - Effective 1/1/2018
(PDF 211.38 KB)

UnitedHealthcare Connected - MyCareOhio
UnitedHealthCare Connected for MyCareOhio - Effective 4/1/2018 (PDF 258.66 KB)
UnitedHealthcare Connected for MyCareOhio - Effective 1/1/2018
(PDF 235.74 KB)

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

UnitedHealthcare Community Plan Prior Authorization OH - Effective 10/1/2017 (PDF 213.12 KB)

UnitedHealthcare Connected for MyCareOhio - Effective 10/1/2017 (PDF 241.1 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 OH - Effective 7/1/2017 (PDF 209.37 KB)

UnitedHealthcare Connected for MyCareOhio - Effective 7/1/2017 (PDF 238.05 KB)

UnitedHealthcare Community Plan Prior Authorization OH - Effective 4/1/2017 (PDF 180.36 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 OH - Effective 2/1/2017 (PDF 173.6 KB)

UnitedHealthcare Community Plan Prior Authorization OH - Effective 1/1/2017 (PDF 173.66 KB)

UnitedHealthcare Community Plan Prior Authorization OH Effective 10/1/2016 (PDF 178.06 KB)

UnitedHealthcare Medicare Solutions and UnitedHealthcare Community Plan Notification / Prior Authorization Requirements -  Effective 10/1/2016 (PDF 277.31 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 OH - Effective 7/1/2016 (PDF 187.81 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 OH - Effective 5/1/2016 (PDF 172.95 KB)

UnitedHealthcare Community Plan Prior Authorization List - OH Effective 1/1/2016 (PDF 194.72 KB)

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

UnitedHealthcare Community Plan Prior Authorization List - Effective 12/7/2015 (PDF 199.71 KB)

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

Advanced Notification Requirements - Effective 6/1/2015 (PDF 203.99 KB)

Advanced Notification Requirements - Effective 10/1/2014 (PDF 329.28 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.

 

Provider Administrative Manuals

Quick Reference Guide for the UnitedHealthcare Administrative Guides (PDF 112.23 KB)

Medicaid
Care Provider Manual (PDF 640.46 KB)

UnitedHealthcare ConnectedTM for MyCare Ohio Medicare-Medicaid Product 
Provider Administrative Manual (PDF 2.1 MB)

 

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.