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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. 

 

문의처


Claims Addresses


Medicaid and NJ Familycare

UnitedHealthcare 커뮤니티 플랜
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
UnitedHealthcare 커뮤니티 플랜
참조: Complaint and Appeals Department
P.O. Box 31364
Salt Lake City, UT 84131-0364

Part D Appeals and Grievance Department
참조: CA124-0197
P.O. Box 6106
Cypress, CA 90630-9948

 

UM Appeals

Medicaid and NJ Familycare
UnitedHealthcare 커뮤니티 플랜
참조: UM Appeals Coordinator
P.O. Box 31364
Salt Lake City, UT 84131

UnitedHealthcare Dual Special Needs (HMO SNP)
UnitedHealthcare Dual Complete® One
참조: 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

Outpatient Injectable Chemotherapy Prior Authorization Program Overview (PDF 72.2 KB) 

UnitedHealthcare Medicare Solutions & UnitedHealthcare Community Plan
UnitedHealthcare Medicare Prior Authorization Requirements - Effective 1/1/2018 (PDF 282.37 KB)

UnitedHealthcare 커뮤니티 플랜
UnitedHealthcare Community Plan Prior Authorization NJ - Effective 1/1/2018 (PDF 235.2 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)

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)

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.