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진료를 할 주를 선택하십시오.
UnitedHealthcare Community Plan Hawaii Providers

Aloha and welcome to UnitedHealthcare Community Plan!

이곳에서는 UHC 커뮤니티 플랜과 사업을 진행하는 데 필요한 정보와 링크를 제공합니다.  페이지의 왼쪽에 있는 탐색 버튼 중 하나를 클릭하여 관심 있는 주제를 선택하거나 아래에서 자세한 내용을 확인할 주제 또는 상품을 선택하십시오.

Contact Us - QUEST Integration (PDF 75.12 KB)

Report Health Care Fraud, Waste and Abuse: 844-359-7736 or uhc.com/fraud

 

Medicaid Managed Care Rule External FAQ’s (PDF 64.57 KB)

Medicaid Managed Care Rule Presentation (PDF 90.71 KB)

 

HIPAA Claim Edits

UnitedHealthcare applies HIPAA edits to professional (837p) and Institutional (837i) claims submitted electronically. Visit the EDI Claim Edits page for more information including a complete list of edits, edits related to ICD-10 codes and applicable payers.

Claims that reject for HIPAA edits will appear on a clearinghouse level report, enabling you to Identify and correct rejected Information prior to UnitedHealthcare receiving the claim.

 

서비스 제공 방식의 변경 사항 및 업데이트

서비스 제공 방식의 모든 변경 사항이나 업데이트는 이 포털의 "서비스 제공 방식 변경 사항 및 업데이트" 섹션, 제공자 뉴스레터 또는 게시판, 제공자 교육 및 훈련 세션, 기타 다양한 형태의 커뮤니케이션 수단을 통해 안내해 드립니다.  

 

 

Prior Authorization

QUEST Integration Prior Authorization Request Form (PDF 296.87 KB)

HI Medicare DSNP Prior Authorization Request Form (PDF 577.61 KB)

UnitedHealthcare 커뮤니티 플랜
UnitedHealthcare Community Plan Prior Authorization HI - Effective 1/1/2018 (PDF 213.48 KB)

UnitedHealthcare Medicare Solutions and United Healthcare Community Plan
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 HI - Effective 10/1/2017 (PDF 195.47 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 HI - Effective 7/1/2017 (PDF 194.84 KB)

UnitedHealthcare Community Plan Prior Authorization HI - Effective 4/1/2017 (PDF 192.85 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 HI - Effective 1/1/2017 (PDF 190.49 KB)

UnitedHealthcare Medicare Solutions and UnitedHealthcare Community Plan Notification / Prior Authorization Requirements -  Effective 10/1/2016 (PDF 277.31 KB)

UnitedHealthcare Community Plan Prior Authorization HI - Effective 10/1/2016 (PDF 195.36 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 HI - Effective 7/1/2016 (PDF 193.19 KB)

UnitedHealthcare Medicare Solutions and UnitedHealthcare Community Plan Notification/Prior Authorization Requirements - Effective 5/1/2016 (PDF 251.42 KB)

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

Advanced Notification Requirements for HI - Effective Jan. 15, 2015 (PDF 489.67 KB)

 

주사형 약품

의료 혜택으로 보장되는 전문 약국 의약품은 가정 투여 제공자, 외래 시설, 의사, 전문 약국 등 다양한 채널을 통해 제공될 수 있습니다.

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.

 

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.