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Mangyaring piliin ang estado kung saan ka nagtatrabaho.

Welcome to the UnitedHealthcare Community Plan Health Professionals area for Pennsylvania providers.

Dito, makikita mo ang impormasyon at mga link na kailangan mo upang maisagawa ang gagawin sa Planong Pangkomunidad ng UHC. Choose your topic of interest by selecting one of the left navigation buttons. 

Medicaid Managed Care Rule External FAQs (PDF 64.57 KB) (PDF 90.71 KB)

Medicaid Managed Care Rule Presentation (PDF 90.71 KB)

 

Provider Call Center

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

Postal Mailing Address

Planong Pangkomunidad ng UnitedHealthcare
2 Allegheny Center Suite 600
Pittsburgh, PA 15212 

Claims Mailing Address

Planong Pangkomunidad ng UnitedHealthcare
PO Box 8207
Kingston, NY 12402-8207

Utilization Management Appeals Address   

Planong Pangkomunidad ng UnitedHealthcare
Paunawa: Grievances and Appeals
PO Box 31364
Salt Lake City, UT 84131-0364

Claims Appeals Mailing Address

Part C Appeals and Grievance Department
Planong Pangkomunidad ng UnitedHealthcare
Paunawa: Complaint and Appeals Department
P.O. Box 31364
Salt Lake City, UT 84131-0364

 

 

Part D Appeals and Grievance Department
Paunawa: CA124-0197
P.O. Box 6106
Cypress, CA 90630-9948

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

Prior Authorization

UnitedHealthcare Outpatient Injectable Chemotherapy Prior Authorization Program Overview (PDF 72.33 KB)

UnitedHealthcare Medicare Solutions & UnitedHealthcare Community Plan
UnitedHealthcare Medicare Prior Authorization Requirements - Effective 4/1/2018 (PDF 293.21 KB)

UnitedHealthcare Community Plan - CHIP
UnitedHealthcare Community Plan Prior Authorization PA CHIP - Effective 4/1/2018 (PDF 258.34 KB)

UnitedHealthcare Community Plan - CAID
UnitedHealthcare Community Plan Prior Authorization PA CAID - Effective 4/1/2018 (PDF 242.21 KB)

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

UnitedHealthcare Community Plan Prior Authorization PA CHIP - Effective 1/1/2018 (PDF 258.32 KB)

  (PDF 258.32 KB)UnitedHealthcare Community Plan Prior Authorization PA CAID - Effective 1/1/2018 (PDF 237.6 KB) (PDF 286.74 KB)

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

UnitedHealthcare Community Plan Prior Authorization PA CHIP - Effective 10/1/2017 (PDF 272.81 KB)

UnitedHealthcare Community Plan Prior Authorization PA CAID - Effective 10/1/2017 (PDF 250.29 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 PA CHIP - Effective 7/1/2017 (PDF 264.72 KB)

UnitedHealthcare Community Plan Prior Authorization PA CAID - Effective 7/1/2017 (PDF 241.88 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 PA CHIP - Effective 1/1/2017 (PDF 233.97 KB)

UnitedHealthcare Community Plan Prior Authorization PA CAID - Effective 1/1/2017 (PDF 215 KB)

UnitedHealthcare Community Plan Prior Authorization PA CHIP - Effective 10/1/2016 (PDF 231 KB)

UnitedHealthcare Community Plan Prior Authorization PA CAID - Effective 10/1/2016 (PDF 209.76 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 PA CAID - Effective 7/1/2016 (PDF 210.33 KB)

UnitedHealthcare Community Plan Prior Authorization PA CHIP - Effective 7/1/2016 (PDF 210.81 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 PA - Effective 5/1/2016 (PDF 213.32 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. 

View the clinical criteria and guidelines used to conduct medical necessity reviews.

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.