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As of January 1st, 2018 UnitedHealthcare Community Plan will no longer provide Medicaid and Long Term Care coverage in Delaware.   For questions about 2018 services, members can call their new Health Plan Member Service’s phone number, it is on their ID card. If members have questions related to any services prior to January 1, 2018, members can call United Healthcare Community Plan member services at 1-877-877-8159

This change doesn’t affect UnitedHealthcare Medicare, including Institutional Special Needs Plan (I-SNP) and Dual Complete Plan (DSNP) or UnitedHealthcare Commercial Plan members.

Healthcare Providers can continue to call Provider Services at 1-800-600-9007.  For questions regarding behavioral health, please call 1-877-614-0484.  For questions regarding Dental, please call 1-855-609-5152.

 

Vui lòng chọn tiểu bang hành nghề của quý vị.
UnitedHealthcare Community Plan Delaware Providers

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

Ở đây quý vị sẽ tìm thấy mọi thông tin, biểu mẫu, sách hướng dẫn và đường dẫn cần thiết để thực hiện công việc với Chương Trình Cộng Đồng UnitedHealthcare.

Attention Providers: Some phone numbers for UHC staff members have changed. Click "Contact Us" for the updated information.

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:

Nhà Thuốc Chuyên Ngành Trong Hệ Thống

Số Điện Thoại

BriovaRx

855-427-4682

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

Nhà Thuốc Chuyên Ngành Trong Hệ Thống

Loại Thuốc

Số Điện Thoại

Accredo (nursing services)

Thiếu Enzyme

Bệnh Gaucher

Miễn Dịch Globulin

Tăng Áp Phổi

800-803-2523

 

Option Care (nursing services)

Thiếu Enzyme

Bệnh Gaucher

Chứng rối loạn đông máu

Miễn Dịch Globulin

Bệnh Makena

866-827-8203

Nhà Thuốc Chuyên Ngành CVS Caremark

Tăng Áp Phổi

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.

Wellness Registry for Delaware Community Plan Providers

The Wellness Registry is a community services database that contains resources throughout the State of Delaware that can assist in meeting our member’s needs.  It will help you connect members to wellness programs, such as health education and disease management classes. UniteHealthcare uses the Healthify database as the wellness registry.

To access the Wellness Registry:

  1. Click on the Link button at the top right of UHCprovider.com and  sign in with your Optum ID
  2. From the Link Dashboard, navigate to the Menu at the top left and choose myData Connection Dashboard
  3. Then,  from the myData Connection dashboard, click on the Community Resource Finder tile to access the Healthify Wellness Registry

 

Health Plan NCQA AccreditationUnitedHealthcare Community Plan received NCQA New Health Plan Accreditation on July 7, 2010. NCQA's mission is to improve the quality of health care, and participating in their accreditation process is voluntary. NCQA’s New Health Plan Accreditation Program applies to health plans that are less than 36 months old. The program is distinct from NCQA's MCO Accreditation Program. NCQA Accreditation is a nationally recognized evaluation that purchasers, regulators, and consumers can use to assess managed care plans.

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 DE CAID CHIP - Effective 7/1/2017 (PDF 263,57 KB)

UnitedHealthcare Community Plan Prior Authorization DE LTC - Effective 7/1/2017 (PDF 241,72 KB)

UnitedHealthcare Community Plan Prior Authorization DE CAID CHIP - Effective 4/1/2017 (PDF 265,39 KB)

UnitedHealthcare Community Plan Prior Authorization DE LTC - Effective 4/1/2017 (PDF 245,47 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 DE CAID CHIP - Effective 1/1/2017 (PDF 252,94 KB)

UnitedHealthcare Community Plan Prior Authorization DE LTC - Effective 1/1/2017 (PDF 227,87 KB)

UnitedHealthcare Community Plan Prior Authorization DE CAID CHIP - Effective 10/1/2016 (PDF 253,63 KB)

UnitedHealthcare Community Plan Prior Authorization DE LTC - Effective 10/1/2016 (PDF 237,67 KB)

UnitedHealthcare Community Plan Prior Authorization DE LTC - Effective 7/1/2016 (PDF 206,59 KB)

UnitedHealthcare Community Plan Prior Authorization DE CAID/CHIP - Effective 7/1/2016 (PDF 210,01 KB)

UnitedHealthcare Community Plan Prior Authorization DE - Effective 5/1/2016 (PDF 201,1 KB)

UnitedHealthcare Community Plan Prior Authorization DE - Effective 1/1/2016 (PDF 222,71 KB)

Prior Authorization (PDF 221,84 KB) - Effective December 7, 2015

Advanced Notification Requirements for Delaware - Effective June 1, 2015 (PDF 217,82 KB)

Advanced Notification Requirements for Delaware  - Effective Oct. 1, 2014 (PDF 260,49 KB)

 

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. Những chính sách và hướng dẫn này được cung cấp nhằm mục đích thông tin, và không thiết lập thành ý kiến tư vấn y khoa.
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

Yêu cầu khai đúng sự thật của các Yêu Cầu Bảo Hiểm, Báo Cáo, và Trình Bày với Chính Phủ

Tập Đoàn UnitedHealth yêu cầu tuân theo các quy định của luật pháp tiểu bang và liên bang, nghiêm cấm việc nộp các yêu cầu bảo hiểm gian lận có liên quan đến các chương trình chăm sóc sức khoẻ của liên bang, bao gồm Medicare và Medicaid. 
View our policy (PDF 38,15 KB).

Miễn Trách

If UHG policies conflict with provisions of a state contract or with state or federal law, the contractual / statutory / regulatory provisions shall prevail. Để xem các thay đổi chính sách được cập nhật, hãy chọn phần Bản Tin ở bên trái.