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UnitedHealthcare Community Plan New Jersey Providers

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Liên Hệ

 

Provider Service Center

888-362-3368 available Monday – Friday: 8 giờ sáng – 6 giờ tối


Claims Addresses


Medicaid and NJ Familycare

Chương Trình Cộng Đồng UnitedHealthcare
P.O. Box 5250
Kingston, NY 12402-5250
Payer ID: 86047 

UnitedHealthcare Dual Complete ONE
UnitedHealthcare Dual Complete® ONE
P.O. Box 5250
Kingston, NY 12402-5250
Payer ID: 86047

 

Claims Appeal Address

Part C Appeals and Grievance Department
Chương Trình Cộng Đồng UnitedHealthcare
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

 

UM Appeals

Medicaid and NJ Familycare
Chương Trình Cộng Đồng UnitedHealthcare
Attn: UM Appeals Coordinator
P.O. Box 31364
Salt Lake City, UT 84131

UnitedHealthcare Dual Special Needs (HMO SNP)
UnitedHealthcare Dual Complete® One
Attn: UM Appeals Coordinator
P.O. Box 31364
Salt Lake City, UT 84131

 

 

Prior Authorization

Outpatient Injectable Chemotherapy Prior Authorization Program Overview (PDF 72,2 KB) 

UnitedHealthcare Medicare Solutions & UnitedHealthcare Community Plan
UnitedHealthcare Medicare Prior Authorization Requirements - Effective 4/1/2018 (PDF 293,21 KB)

Chương Trình Cộng Đồng UnitedHealthcare
UnitedHealthcare Community Plan Prior Authorization NJ - Effective 4/1/2018 (PDF 515,81 KB)

UnitedHealthcare Community Plan Prior Authorization NJ - Effective 1/1/2018 (PDF 235,2 KB)

 

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

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

UnitedHealthcare Community Plan Prior Authorization NJ - Effective 10/1/2017 (PDF 260,14 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 NJ - Effective 7/1/2017 (PDF 250,58 KB)

UnitedHealthcare Community Plan Prior Authorization NJ - Effective 4/1/2017 (PDF 245,76 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 NJ - Effective 1/1/2017 (PDF 226,68 KB)

UnitedHealthcare Community Plan Prior Authorization NJ Effective 10/1/2016 (PDF 228,61 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 NJ Effective 7/1/2016 (PDF 201,66 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 List NJ Effective 5/1/2016 (PDF 205,32 KB)

UnitedHealthcare Community Plan Prior Authorization - NJ Effective 1/1/2016 (PDF 211,39 KB)

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

 

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.