UnitedHealthcare Community Plan
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We continue to ensure that all documents are updated for ICD-10 Terminology. Providers should be aware that ICD-9 content applies to dates of service prior to 10/1/2015. ICD-10 terminology and claims sets apply to dates of service 10/1/2015 and after, regardless of the status of the document. 

Please select the state where you practice.

UnitedHealthcare Community Plan Ohio Providers

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

Here you will find the information, forms, manuals and links you need to conduct business with UnitedHealthcare Community Plan.

Attention Providers:  The Ohio Department of Medicaid has recently changed its policy on record retention per OAC 5160-26-06.  The UnitedHealthcare Community Plan Provider Agreement has changed for the retention of all records, including medical records and financial documents. 

UnitedHealthcare Community Plan Added to Electronic Payments & Statements (PDF 59.89 KB)

Contact Us

Click on the arrow above to view contact information. 

 

Provider Call Center

 

 

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

 

Postal Mailing Address

 

 

UnitedHealthcare Community Plan
9200Worthington Road, 3rd Floor
Westerville, OH 43082

 

Claims Mailing Address

 

 

UnitedHealthcare Community Plan
P.O. Box 8207
Kingston, NY 12402

 

Utlization Management Appeals Address   

 

 

UnitedHealthcare Community Plan
Attn: Complaint and Appeals Department
P.O. Box 31364
Salt Lake City, UT 84131
Fax: (801) 994-1082

 

Claims Appeals Mailing Address

 

 

UnitedHealthcare Community Plan
Attn: Complaint and Appeals Department
P.O. Box 31364
Salt Lake City, UT 84131
Fax: (801) 994-1082

 

UHC Connected™ For MyCare
Ohio Appeals Mailing Address

 

 

Part C Appeals or Grievances:
UnitedHealthcare Community Plan
Attn: Complaint and Appeals Department
P.O. Box 31364
Salt Lake City, UT 84131
Fax: (801) 994-1082

Medicare Part D Grievances:
UnitedHealthcare Community Plan
Attn: Complaint and Appeals Department
P.O. Box 31364
Salt Lake City, UT 84131
Fax: (801) 994-1082

Medicare Part D Appeals:
UnitedHealthcare Community Plan
Attn: Part D Standard Appeals
P.O. Box 6103
Cypress, CA 90630-9998
Fax: (877) 960-8235

 

 

ICD-10 Tips

 

The Ohio Department of Medicaid (ODM) ICD-10 team will post monthly ICD-10 TIPS which will offer clarification and guidance to ODM providers and ODM staff on the transition to the ICD-10 codes. The following links will take you to ODM resources concerning the ICD-10 transition.

Ohio Department of Medicaid ICD-10 Web Page

Ohio Department of Medicaid ICD-10 Webinar for Physician Practices (PDF 262.76 KB)

Ohio Department of Medicaid ICD-10 TIPS #1 - Claims Compliance Date

Ohio Department of Medicaid ICD-10 - TIPS #2 Span Date Billing (PDF 84.17 KB)

Ohio Department of Medicaid ICD-10 - TIPS #3 Dental Claims (PDF 166.03 KB)

Ohio Department of Medicaid ICD-10 - TIPS #4 Unspecified Codes (PDF 167 KB)

Ohio Department of Medicaid ICD-10 - TIPS #5 Inpatient Hospital Interim Billing (PDF 167.52 KB)

Ohio Department of Medicaid ICD-10 - TIPS #6 Inpatient Prior Authorization (PDF 170.6 KB)

Ohio Department of Medicaid ICD-10 - TIPS #9 Child Birth Delivery and Weeks of Gestation Diagnosis Codes (PDF 563.61 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.

Medical Injectables

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.

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 OH - Effective 2/1/2017 (PDF 173.6 KB)

UnitedHealthcare Community Plan Prior Authorization OH - Effective 1/1/2017 (PDF 173.66 KB)

UnitedHealthcare Community Plan Prior Authorization OH Effective 10/1/2016 (PDF 178.06 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 OH - Effective 7/1/2016 (PDF 187.81 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 OH - Effective 5/1/2016 (PDF 172.95 KB)

UnitedHealthcare Community Plan Prior Authorization List - OH Effective 1/1/2016 (PDF 194.72 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 199.71 KB)

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

Advanced Notification Requirements - Effective 6/1/2015 (PDF 203.99 KB)

Advanced Notification Requirements - Effective 10/1/2014 (PDF 329.28 KB)

 

Provider Administrative Manuals

Medicaid
Medicaid OH Provider Administrative Manual (PDF 1.38 MB)

UnitedHealthcare ConnectedTM for MyCare Ohio Medicare-Medicaid Product 
Provider Administrative Manual (PDF 2.11 MB)

 

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.