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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. 

 

Provider Call Center

 

 

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

 

Postal Mailing Address

 

 

UnitedHealthcare 커뮤니티 플랜
9200Worthington Road, 3rd Floor
Westerville, OH 43082

 

Claims Mailing Address

 

 

UnitedHealthcare 커뮤니티 플랜
P.O. Box 8207
Kingston, NY 12402

 

Utlization Management Appeals Address   

 

 

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

 

Claims Appeals Mailing Address

 

 

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

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

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

 


 

Prior Authorization

The Prior Authorization lists below are not an indication that other codes not appearing on these lists are covered. Before providing services, providers should check the following for coverage limiations and information:

UnitedHealthcare Outpatient Injectable Chemotherapy Prior Authorization Program Overview  (PDF 72.17 KB)

UnitedHealthcare Medicare Solutions & UnitedHealthcare Community Plan
UnitedHealthcare Medicare Prior Authorization Requirements - Effective 4/1/2018 (PDF 293.21 KB)

UnitedHealthcare 커뮤니티 플랜
UnitedHealthcare Community Plan Prior Authorization OH - Effective 4/1/2018 (PDF 212.58 KB)
UnitedHealthcare Community Plan Prior Authorization OH - Effective 1/1/2018
(PDF 211.38 KB)

UnitedHealthcare Connected - MyCareOhio
UnitedHealthCare Connected for MyCareOhio - Effective 4/1/2018 (PDF 258.66 KB)
UnitedHealthcare Connected for MyCareOhio - Effective 1/1/2018
(PDF 235.74 KB)

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 OH - Effective 10/1/2017 (PDF 213.12 KB)

UnitedHealthcare Connected for MyCareOhio - Effective 10/1/2017 (PDF 241.1 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 OH - Effective 7/1/2017 (PDF 209.37 KB)

UnitedHealthcare Connected for MyCareOhio - Effective 7/1/2017 (PDF 238.05 KB)

UnitedHealthcare Community Plan Prior Authorization OH - Effective 4/1/2017 (PDF 180.36 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 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)

 

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.

 

Provider Administrative Manuals

Quick Reference Guide for the UnitedHealthcare Administrative Guides (PDF 112.23 KB)

Medicaid
Care Provider Manual (PDF 650.93 KB)

UnitedHealthcare ConnectedTM for MyCare Ohio Medicare-Medicaid Product 
Ohio MyCare Provider Manual (PDF 2 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. 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.