UnitedHealthcare Community Plan
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UnitedHealthcare Community Plan New Jersey Providers

You don't have time to spare: that's why we put all the documents you need in one place. Use the navigation items on the left to find what you're looking for fast.

 

 

Provider Training

Adult Medical Day Care Services - June 1, 2017 

This session is designed to give stakeholders a better understanding of the best practices to prevent, avoid, and detect fraud, waste, and abuse relating to adult medical day care services.

Learn more about the training session and register for the session (PDF 261 KB).

 

Contact Us

Claims Addresses

Medicaid and NJ Familycare
UnitedHealthcare Community Plan
P.O. Box 5250
Kingston, NY 12402-5250

UnitedHealthcare Dual Special Needs (HMO SNP)

UnitedHealthcare Dual Complete® One
P.O. Box 5250
Kingston, NY 12402-5250

 

Claims Appeal 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

 

UM Appeals

Medicaid and NJ Familycare
UnitedHealthcare Community Plan
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

 

Provider Service Center

888-362-3368 available Monday – Friday: 8 a.m. – 6 p.m.

 

Prior Authorization Archive

Click on the arrow above to view the prior authorization archive.

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)

UnitedHealthcare Community Plan Prior Authorization List - Effective 12/7/2015 (PDF 217.35 KB)

UnitedHealthcare Medicare Solutions Notification/Prior Authorization List - Effective 1/1/16 (PDF 249.77 KB)

Advanced Notification Requirements for New Jersey Effective June 1, 2015 (PDF 215.11 KB)

Advanced Notification Requirements for New Jersey Effective Oct. 1, 2014 (PDF 259.58 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.

Click on the arrow above to view medical injectable information. 

For physicians who do not want to buy-and-bill a specialty pharmacy medication that is covered on the Medical Benefit, they may choose to source it through a network specialty pharmacy:

Network Specialty Pharmacy

Phone Number

OptumRx

866-218-7398

BioScrip (offers nursing services)

• also a National Home Infusion Provider for Medical Benefit medications

866-788-7710

The following specialty pharmacies may also provide specific categories of specialty pharmacy medications:

Network Specialty Pharmacy

Medication Category

Phone Number

Accredo (offers nursing services)

Enzyme Deficiency

Gaucher's Disease

Immune Globulin

Pulmonary Hypertension


800-803-2523

 

Option Care (offers nursing services)

Cardiovascular/Heart Failure

Enzyme Deficiency

Gaucher's Disease

Hemophilia

Immune Globulin

Makena

866-827-8203

CVS Caremark Specialty Pharmacy

Enzyme Deficiency

Gaucher's Disease

Makena

Pulmonary Hypertension

800-237-2767

Coverage of the requested drug is dependent on the member's benefits, and the availability of a specific drug from a network specialty pharmacy may vary.

The Specialty Pharmacy can deliver the medication to the healthcare practitioner's office or another site (ex. patient's home) upon request, and the Specialty Pharmacy will bill the patient's health plan directly.

 

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

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.