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Member Health Waivers 

If you are a provider of a member whose health was previously cared for under one of the following waivers, please contact Provider Services for extra help understanding your full benefit program:

  • Project Aids Care (PAC) Waiver
  • Traumatic Brain Injury (TBI) or Spinal Cord Injury (SCI) Waiver
  • Adult Cystic Fibrosis (ACF) Waiver

You can reach our Provider Services team by calling the number on the back of your members ID card, or by referencing the contact numbers below:

Managed Medical Assistance (MMA): 877-842-3210
Long Term Care (LTC): 800-791-9233

 

Prior Authorization

Florida Pre-Service Reconsideration Request Form (PDF 35,2 KB)

Florida Pre-Service Reconsideration Process – Effective Nov. 1, 2017 (PDF 45,34 KB)

UnitedHealthcare Medicare Solutions & UnitedHealthcare Community Plan

UnitedHealthcare Medicare Prior Authorization Requirements - Effective 1/1/2018 (PDF 282,37 KB)

UnitedHealthcare Community Plan - Florida 

UnitedHealthcare Community Plan Prior Authorization FL - Effective 1/1/2018 (PDF 238,19 KB)

UnitedHealthcare Medicare Prior Authorization Requirements - Effective 10/1/2017 (PDF 286,74 KB)

Site of Service for Outpatient Surgical Procedures FAQ - Effective 12/1/15 (PDF 251,42 KB)

UnitedHealthcare Community Plan Prior Authorization FL - Effective 10/1/2017 (PDF 241,15 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 FL - Effective 9/1/2017 (PDF 234,83 KB)

UnitedHealthcare Community Plan Prior Authorization FL - Effective 7/1/2017 (PDF 221,33 KB)

UnitedHealthcare Community Plan Prior Authorization FL - Effective 6/1/2017 (PDF 221,31 KB)

UnitedHealthcare Medicare Solutions and UnitedHealthcare Community Plan-Medicare Notification/Prior Authorization Requirements - Effective 5/1/2017 (PDF 299,55 KB)

UnitedHealthcare Community Plan Prior Authorization FL - Effective 4/1/2017 (PDF 218,33 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 FL - Effective 2/1/2017 (PDF 214,63 KB)

UnitedHealthcare Community Plan Prior Authorization FL - Effective 1/1/2017 (PDF 211,49 KB)

UnitedHealthcare Community Plan Prior Authorization FL - Effective 10/1/2016 (PDF 213,96 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 FL - Effective 10/1/2016 (PDF 213,96 KB)

UnitedHealthcare Community Plan Prior Authorization FL Effective 7/1/2016 (PDF 195,49 KB)

UnitedHealthcare Medicare Solutions and UnitedHealthcare Community Plan Notification/Prior Authorization Requirements Effective 7/1/2016 (PDF 266,74 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 FL - Effective 5/1/2016 (PDF 197,68 KB)

UnitedHealthcare Medicare Solutions Notification/Prior Authorization List - Effective 1/1/16 (PDF 250,02 KB)

UnitedHealthcare Community Plan Prior Authorization - Effective 12/7/2015 (PDF 173,01 KB)

UnitedHealthcare Medicare Solutions Notification/Prior Authorization List - Effective 1/1/16 (PDF 249,77 KB)

Advance Notification Requirements for Florida, Effective 6/1/2015 (PDF 173,6 KB)

Advance Notification Requirements for Florida, Effective 3/1/2015 (PDF 467,44 KB)

 

Thuốc Tiêm Y Tế

Các loại thuốc chuyên ngành trong nhà thuốc được bao trả trong Quyền Lợi Y Tế có thể được cung cấp qua nhiều kênh khác nhau – nhà cung cấp tiêm truyền tại nhà, cơ sở điều trị ngoại trú, bác sĩ, hoặc nhà thuốc chuyên ngành.

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.

 

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.