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請選擇您執業的所在州。
UnitedHealthcare Community Plan Hawaii Providers

Aloha and welcome to UnitedHealthcare Community Plan!

在此您將找到與 UHC 社區計劃合作共事所需的資訊與連結。 請選擇您感興趣的主題,選擇時請點按本頁左方其中一個導覽按鈕,或直接從下方的主題或產品選擇一項,以檢視詳細說明。

Contact Us - QUEST Integration (PDF 75.12 KB)

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

 

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

 

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.

 

服務交付變更與更新

任何服務交付變更與更新將透過本網站的「服務交付變更與更新」部分、服務提供者電子報或公告欄、服務提供者教育與訓練課堂上,以及其他通訊方式發布並通知。

 

文化迎合計劃(PDF 檔 277.97 KB)

文化迎合訓練(PDF 檔 1.31 MB)

 

Prior Authorization

QUEST Integration Prior Authorization Request Form (PDF 296.87 KB)

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

UnitedHealthcare Community Plan
UnitedHealthcare Community Plan Prior Authorization HI - Effective 4/1/2018 (PDF 181.62 KB)

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

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

 

UnitedHealthcare Community Plan Prior Authorization HI - Effective 1/1/2018 (PDF 213.48 KB)

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

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

 

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。

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。