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Provider Manual

2018 Washington Apple Health Care Provider Manual (PDF 1.04 MB) - 3.2.2018

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

 

Prior Authorization

UnitedHealthcare Outpatient Injectable Chemotherapy Prior Authorization Program Overview (PDF 72.29 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 WA - Effective 4/1/2018 (PDF 232.35 KB)

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

 

UnitedHealthcare Community Plan Prior Authorization WA - Effective 1/1/2018  (PDF 233.05 KB)

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

UnitedHealthcare Community Plan Prior Authorization WA - Effective 10/1/2017 (PDF 245.49 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 WA - Effective 7/1/2017 (PDF 235.5 KB)

UnitedHealthcare Community Plan Prior Authorization WA - Effective 4/1/2017 (PDF 225.06 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 WA - Effective 1/1/2017 (PDF 225.54 KB)

UnitedHealthcare Community Plan Prior Authorization WA - Effective 10/1/2016 (PDF 219.2 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 WA - Effective 7/1/2016 (PDF 213.47 KB)

UnitedHealthcare Medicare Solutions and UnitedHealthcare Community Plan Notification/Prior Authorization Requirements - Effective 7/1/2016 (PDF 266.74 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 WA - Effective 5/1/2016 (PDF 215.72 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 Training Materials

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

 

News

Fostering Positive Youth Development: Opportunities to Reframe the Conversation About Trauma
April 1, 2016, 10:00–11:00 a.m. How might we create school systems and services that engage young people to improve their experience of school climate and wellness? This webinar will explore frameworks and approaches for developing effective youth leadership and positive school climate in your school community, unpacking how and why youth voice is essential to building healthy school climates and cultures. Specific challenges with youth engagement will be discussed.

Self and Collective Care of Youth-Serving Adults
April 8, 2016, 10:00–11:00 a.m. Students are at the center of our work. At the same time, adults in our school communities need support in order to show up for the young people they serve. This webinar will explore how we can create cultures of care not only for youth, but also for the adults who work with them. 



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.