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진료를 할 주를 선택하십시오.

Welcome to the UnitedHealthcare Community Plan Health Professionals area for Pennsylvania providers.

이곳에서는 UHC 커뮤니티 플랜과 사업을 진행하는 데 필요한 정보와 링크를 제공합니다. Choose your topic of interest by selecting one of the left navigation buttons. 

Medicaid Managed Care Rule External FAQs (PDF 64.57 KB) (PDF 90.71 KB)

Medicaid Managed Care Rule Presentation (PDF 90.71 KB)

 

Provider Call Center

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

Postal Mailing Address

UnitedHealthcare 커뮤니티 플랜
2 Allegheny Center Suite 600
Pittsburgh, PA 15212 

Claims Mailing Address

UnitedHealthcare 커뮤니티 플랜
PO Box 8207
Kingston, NY 12402-8207

Utilization Management Appeals Address   

UnitedHealthcare 커뮤니티 플랜
참조: Grievances and Appeals
PO Box 31364
Salt Lake City, UT 84131-0364

Claims Appeals Mailing 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

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

Prior Authorization

UnitedHealthcare Outpatient Injectable Chemotherapy Prior Authorization Program Overview (PDF 72.33 KB)

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

UnitedHealthcare Community Plan - CHIP
UnitedHealthcare Community Plan Prior Authorization PA CHIP - Effective 4/1/2018 (PDF 258.34 KB)

UnitedHealthcare Community Plan - CAID
UnitedHealthcare Community Plan Prior Authorization PA CAID - Effective 4/1/2018 (PDF 242.21 KB)

UnitedHealthcare Medicare Prior Authorization Requirements - Effective 1/1/2018  (PDF 282.37 KB)

UnitedHealthcare Community Plan Prior Authorization PA CHIP - Effective 1/1/2018 (PDF 258.32 KB)

  (PDF 258.32 KB)UnitedHealthcare Community Plan Prior Authorization PA CAID - Effective 1/1/2018 (PDF 237.6 KB) (PDF 286.74 KB)

 UnitedHealthcare Medicare Prior Authorization Requirements - Effective 10/1/2017 (PDF 286.74 KB)

UnitedHealthcare Community Plan Prior Authorization PA CHIP - Effective 10/1/2017 (PDF 272.81 KB)

UnitedHealthcare Community Plan Prior Authorization PA CAID - Effective 10/1/2017 (PDF 250.29 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 PA CHIP - Effective 7/1/2017 (PDF 264.72 KB)

UnitedHealthcare Community Plan Prior Authorization PA CAID - Effective 7/1/2017 (PDF 241.88 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 PA CHIP - Effective 1/1/2017 (PDF 233.97 KB)

UnitedHealthcare Community Plan Prior Authorization PA CAID - Effective 1/1/2017 (PDF 215 KB)

UnitedHealthcare Community Plan Prior Authorization PA CHIP - Effective 10/1/2016 (PDF 231 KB)

UnitedHealthcare Community Plan Prior Authorization PA CAID - Effective 10/1/2016 (PDF 209.76 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 PA CAID - Effective 7/1/2016 (PDF 210.33 KB)

UnitedHealthcare Community Plan Prior Authorization PA CHIP - Effective 7/1/2016 (PDF 210.81 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 PA - Effective 5/1/2016 (PDF 213.32 KB)

주사형 약품

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

View the clinical criteria and guidelines used to conduct medical necessity reviews.

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.