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UnitedHealthcare Community Plan New Jersey Providers

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Provider Training

Adult Medical Day Care Services - June 1, 2017 

This session is designed to give stakeholders a better understanding of the best practices to prevent, avoid, and detect fraud, waste, and abuse relating to adult medical day care services.

Learn more about the training session and register for the session (PDF 261 KB).

 

Contact Us

Claims Addresses

Medicaid and NJ Familycare
UnitedHealthcare Community Plan
P.O. Box 5250
Kingston, NY 12402-5250

UnitedHealthcare Dual Special Needs (HMO SNP)

UnitedHealthcare Dual Complete® One
P.O. Box 5250
Kingston, NY 12402-5250

 

Claims Appeal Address

Part C Appeals and Grievance Department
UnitedHealthcare Community Plan
Attn: Complaint and Appeals Department
P.O. Box 31364
Salt Lake City, UT 84131-0364

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

 

UM Appeals

Medicaid and NJ Familycare
UnitedHealthcare Community Plan
Attn: UM Appeals Coordinator
P.O. Box 31364
Salt Lake City, UT 84131

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

 

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 one of the following network specialty pharmacies:

Network Specialty Pharmacy

Phone Number

BriovaRx

866-815-5338

BioScrip (offers nursing services)

• also serves as a national home infusion provider for medical benefit medications

866-788-7710

The following specialty pharmacies also provide certain types of specialty medications:

Network Specialty Pharmacy

Medication Category

Phone Number

Accredo (nursing services)

Enzyme Deficiency

Gaucher's Disease

Immune Globulin

Pulmonary Hypertension

800-803-2523

 

Option Care (nursing services)

Cardiovascular/Heart Failure

Enzyme Deficiency

Gaucher's Disease

Hemophilia

Immune Globulin

Makena

866-827-8203

CVS Caremark Specialty Pharmacy

Pulmonary Hypertension

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. These policies and guidelines are provided for informational purposes, and do not constitute medical advice.
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

Integrity of Claims, Reports, and Representations to the Government

UnitedHealth Group requires compliance with the requirements of federal and state laws that prohibit the submission of false claims in connection with federal health care programs, including Medicare and Medicaid. 
View our policy (PDF 38.15 KB).

Disclaimer

If UHG policies conflict with provisions of a state contract or with state or federal law, the contractual / statutory / regulatory provisions shall prevail. To see updated policy changes, select the Bulletin section at left.