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As of January 1st, 2018 UnitedHealthcare Community Plan will no longer provide Medicaid and Long Term Care coverage in Delaware.   For questions about 2018 services, members can call their new Health Plan Member Service’s phone number, it is on their ID card. If members have questions related to any services prior to January 1, 2018, members can call United Healthcare Community Plan member services at 1-877-877-8159

This change doesn’t affect UnitedHealthcare Medicare, including Institutional Special Needs Plan (I-SNP) and Dual Complete Plan (DSNP) or UnitedHealthcare Commercial Plan members.

Healthcare Providers can continue to call Provider Services at 1-800-600-9007.  For questions regarding behavioral health, please call 1-877-614-0484.  For questions regarding Dental, please call 1-855-609-5152.

 

진료를 할 주를 선택하십시오.
UnitedHealthcare Community Plan Delaware Providers

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

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

Attention Providers: Some phone numbers for UHC staff members have changed. Click "Contact Us" for the updated information.

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:

전문 약국 네트워크

전화 번호

BriovaRx

855-427-4682

The following specialty pharmacies also provide certain types of specialty medications:

전문 약국 네트워크

의약품 범주

전화 번호

Accredo (nursing services)

적혈구효소결핍증

고셔병

감마글로불린

폐고혈압

800-803-2523

 

Option Care (nursing services)

적혈구효소결핍증

고셔병

혈우병

감마글로불린

마케나

866-827-8203

CVS Caremark 전문 약국

폐고혈압

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.

Wellness Registry for Delaware Community Plan Providers

The Wellness Registry is a community services database that contains resources throughout the State of Delaware that can assist in meeting our member’s needs.  It will help you connect members to wellness programs, such as health education and disease management classes. UniteHealthcare uses the Healthify database as the wellness registry.

To access the Wellness Registry:

  1. Click on the Link button at the top right of UHCprovider.com and  sign in with your Optum ID
  2. From the Link Dashboard, navigate to the Menu at the top left and choose myData Connection Dashboard
  3. Then,  from the myData Connection dashboard, click on the Community Resource Finder tile to access the Healthify Wellness Registry

 

Health Plan NCQA AccreditationUnitedHealthcare Community Plan received NCQA New Health Plan Accreditation on July 7, 2010. NCQA's mission is to improve the quality of health care, and participating in their accreditation process is voluntary. NCQA’s New Health Plan Accreditation Program applies to health plans that are less than 36 months old. The program is distinct from NCQA's MCO Accreditation Program. NCQA Accreditation is a nationally recognized evaluation that purchasers, regulators, and consumers can use to assess managed care plans.

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 DE CAID CHIP - Effective 7/1/2017 (PDF 263.57 KB)

UnitedHealthcare Community Plan Prior Authorization DE LTC - Effective 7/1/2017 (PDF 241.72 KB)

UnitedHealthcare Community Plan Prior Authorization DE CAID CHIP - Effective 4/1/2017 (PDF 265.39 KB)

UnitedHealthcare Community Plan Prior Authorization DE LTC - Effective 4/1/2017 (PDF 245.47 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 DE CAID CHIP - Effective 1/1/2017 (PDF 252.94 KB)

UnitedHealthcare Community Plan Prior Authorization DE LTC - Effective 1/1/2017 (PDF 227.87 KB)

UnitedHealthcare Community Plan Prior Authorization DE CAID CHIP - Effective 10/1/2016 (PDF 253.63 KB)

UnitedHealthcare Community Plan Prior Authorization DE LTC - Effective 10/1/2016 (PDF 237.67 KB)

UnitedHealthcare Community Plan Prior Authorization DE LTC - Effective 7/1/2016 (PDF 206.59 KB)

UnitedHealthcare Community Plan Prior Authorization DE CAID/CHIP - Effective 7/1/2016 (PDF 210.01 KB)

UnitedHealthcare Community Plan Prior Authorization DE - Effective 5/1/2016 (PDF 201.1 KB)

UnitedHealthcare Community Plan Prior Authorization DE - Effective 1/1/2016 (PDF 222.71 KB)

Prior Authorization (PDF 221.84 KB) - Effective December 7, 2015

Advanced Notification Requirements for Delaware - Effective June 1, 2015 (PDF 217.82 KB)

Advanced Notification Requirements for Delaware  - Effective Oct. 1, 2014 (PDF 260.49 KB)

 

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. 이러한 정책과 지침은 정보 제공을 목적으로 제공되는 것으로, 의학적인 조언은 아닙니다.
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

정부에 대한 청구, 보고 및 진술의 무결성

UnitedHealth Group은 메디케어와 메디케이드를 비롯한 연방 건강 보험 프로그램과 관련하여 허위 청구의 제출을 금지하는 연방 법률과 주 법률의 요건을 준수해야 합니다. 
View our policy (PDF 38.15 KB).

사전 고지 사항

If UHG policies conflict with provisions of a state contract or with state or federal law, the contractual / statutory / regulatory provisions shall prevail. 업데이트된 정책 변경 사항을 확인하려면 왼쪽에서 게시판 섹션을 선택하십시오.