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請選擇您執業的所在州。

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

在此您將找到與 UHC 社區計劃合作共事所需的資訊與連結。Choose your topic of interest by selecting one of the left navigation buttons.

Notice:UnitedHealthcare Community Plan Added to Electronic Payments & Statements (PDF 59.89 KB)

Medicaid Managed Care Rule External FAQ’s (PDF 64.57 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

UnitedHealthcare Community Plan
2 Allegheny Center Suite 600
Pittsburgh, PA 15212 

Claims Mailing Address

UnitedHealthcare Community Plan
PO Box 8207
Kingston, NY 12402-8207

Utilization Management Appeals Address   

UnitedHealthcare Community Plan
Attn:Grievances and Appeals
PO Box 31364
Salt Lake City, UT 84131-0364

Claims Appeals Mailing Address

Part C Appeals and Grievance Department
UnitedHealthcare Community Plan
Attn:Complaint and Appeals Department
P.O. Box 31364
Salt Lake City, UT 84131-0364

 

 

Part D Appeals and Grievance Department
Attn: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 1/1/2018 (PDF 282.37 KB)

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

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

UnitedHealthcare Community Plan Prior Authorization PA - Effective 1/1/2016 (PDF 225.41 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 228.04 KB)

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

Advance Notification Requirements for Pennsylvania - Effective 6/1/2015 (PDF 226.15 KB)

Advance Notification Requirements for Pennsylvania - Effective 10/1/2014 (PDF 267.44 KB)

醫療注射

醫療承保福利涵蓋之專賣藥房藥物,可透過多種管道提供 - 居家輸液服務提供者、門診機構、醫師或專賣藥房。

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:

專賣藥房網路

電話號碼

BriovaRx

855-427-4682

The following specialty pharmacies also provide certain types of specialty medications:

專賣藥房網路

藥物種類

電話號碼

Accredo (nursing services)

酶缺乏

高歇氏病

免疫球蛋白

肺循環血壓過高

800-803-2523

 

Option Care (nursing services)

酶缺乏

高歇氏病

血友病

免疫球蛋白

Makena

866-827-8203

CVS Caremark 專賣藥房

肺循環血壓過高

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.這些政策與準則僅供參考,不構成醫療建議。
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

索賠、報告與向政府的陳述屬實

UnitedHealth Group 要求遵守聯邦法與州法的規定,禁止提交與包括 Medicare 與 Medicaid 等聯邦醫療保健計劃相關的不實索賠。
View our policy (PDF 38.15 KB).

免責聲明

If UHG policies conflict with provisions of a state contract or with state or federal law, the contractual / statutory / regulatory provisions shall prevail.欲查看更新後的政策變更,請選擇左方的公告欄部份。