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

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

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)

Medical Injectables

Specialty pharmacy medications covered on the Medical Benefit may be provided through a variety of channels – home infusion provider, outpatient facility, physician, or specialty pharmacy. 

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:

Network Specialty Pharmacy

Phone Number

BriovaRx

855-427-4682

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

Network Specialty Pharmacy

Medication Category

Phone Number

Accredo (nursing services)

Enzyme Deficiency

Gaucher's Disease

Immune Globulin

Pulmonary Hypertension

800-803-2523

 

Option Care (nursing services)

Enzyme Deficiency

Gaucher's Disease

Hemophilia

Immune Globulin

Makena

866-827-8203

CVS Caremark Specialty Pharmacy

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. These policies and guidelines are provided for informational purposes, and do not constitute medical advice.
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

Integrity of Claims, Reports, and Representations to the Government

UnitedHealth Group requires compliance with the requirements of federal and state laws that prohibit the submission of false claims in connection with federal health care programs, including Medicare and 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. To see updated policy changes, select the Bulletin section at left.