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Vui lòng chọn tiểu bang hành nghề của quý vị.

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

Ở đây, quý vị sẽ tìm thấy những thông tin và đường dẫn cần thiết để hợp tác kinh doanh với Chương Trình Cộng Đồng UHC. 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)

Trung Tâm Dịch Vụ Nhà Cung Cấp

800-600-9007
Monday-Friday, 8 a.m. – 5 p.m. 

Postal Mailing Address

Chương Trình Cộng Đồng UnitedHealthcare
2 Allegheny Center Suite 600
Pittsburgh, PA 15212 

Địa Chỉ Gửi Thư Yêu Cầu

Chương Trình Cộng Đồng UnitedHealthcare
PO Box 8207
Kingston, NY 12402-8207

Utilization Management Appeals Address   

Chương Trình Cộng Đồng UnitedHealthcare
Gửi cho: Grievances and Appeals
PO Box 31364
Salt Lake City, UT 84131-0364

Claims Appeals Mailing Address

Part C Appeals and Grievance Department
Chương Trình Cộng Đồng UnitedHealthcare
Gửi cho: Complaint and Appeals Department
P.O. Box 31364
Salt Lake City, UT 84131-0364

 

 

Part D Appeals and Grievance Department
Gửi cho: 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)

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. 

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:

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.