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UnitedHealthcare Community Plan New York Providers

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Provider Call Center

866-362-3368


 

Postal Mailing Address

UnitedHealthcare Community Plan
77 Water Street, 14th Floor
New York, NY 10005

Claims Mailing Address

UnitedHealthcare Community Plan
PO Box 5240
Kingston, NY 12402-5240

Utilization Management Appeals Address   

UnitedHealthcare Community Plan
PO Box 31364
Salt Lake City, UT 84131-0364
Fax: (801) 994-1082

Claims Appeals Mailing Address

Part C Appeals or Grievances:
UnitedHealthcare Community Plan
Attn: Complaint and Appeals Department
P.O. Box 31364
Salt Lake City, UT 84131-0364
Fax: (801) 994-1082

 

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

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

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

 

Provider Resources

Access and Availability Standards (PDF 71.48 KB)
2018 Care Provider Manual: New York Physician, Health Care Professional, Facility and Ancillary Administrative Care (PDF 5.02 MB) - Posted 03.12.2018
New York Administrative Guide Supplement
(PDF 51.94 KB)
Quick Reference Guide for the UnitedHealthcare Administrative Guides
(PDF 112.23 KB)
UnitedHealthcare Community Plan Added to Electronic Payments & Statements
(PDF 59.89 KB)
UnitedHealthcare Community Plan Essential Plan Information Sheet
(PDF 197.7 KB)

 

UnitedHealthcare Community Plan for Families

Prior Authorization Fax Request Form  (PDF 115.21 KB)
Addendum A (PDF 15.57 KB)

UnitedHealthcare Community Plan for Kids

Prior Authorization Fax Request Form (PDF 115.21 KB)
 Addendum A
(PDF 15.57 KB)

Downloadable Directories

These directories list the names and addresses of health care professionals and facilities within this health plan. Each directory can be printed or saved to your computer.

Upstate New York (PDF 4.69 MB)
Upstate New York - Rockland and Westchester (PDF 3.65 MB)
Upstate New York - Broome, Chenango, Clinton, Jefferson, Tioga and Warren  (PDF 2.74 MB)
Downstate New York (PDF 7.93 MB)
Downstate - Manhattan and Bronx  (PDF 6.89 MB)
Downstate - Kings and Richmond  (PDF 6.24 MB)
Personal Care Services Supplemental Directory (PDF 240.66 KB)

 

 

Prior Authorization

UnitedHealthcare Outpatient Injectable Chemotherapy Prior Authorization Program Overview (PDF 72.85 KB)

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

UnitedHealthcare Community Plan
UnitedHealthcare Community Plan Prior Authorization NY - Effective 4/1/2018 (PDF 249.88 KB)

UnitedHealthcare Community Plan Prior Authorization NY - Effective 1/1/2018 (PDF 246.84 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 NY - Effective 10/1/2017 (PDF 256.23 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 NY - Effective 7/1/2017 (PDF 251.62 KB)

UnitedHealthcare Community Plan Prior Authorization NY - Effective 4/1/2017 (PDF 235 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 NY - Effective 1/1/2017 (PDF 224.57 KB)

UnitedHealthcare Community Plan Prior Authorization NY - Effective 10/1/2016 (PDF 226.25 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 NY - Effective 7/1/2016 (PDF 205.74 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 NY - Effective 5/1/2016 (PDF 216.31 KB)

UnitedHealthcare Community Plan Prior Authorization NY - Effective 1/1/2016 (PDF 220.19 KB)

UnitedHealthcare Medicare Solutions Notification/Prior Authorization List - Effective 1/1/16 (PDF 250.02 KB)

UnitedHealthcare Medicare Solutions Notification/Prior Authorization List - Effective 1/1/16 (PDF 249.77 KB)

UnitedHealthcare Community Plan Prior Authorization List - Effective 12/7/2015 (PDF 230.1 KB)

Advanced Notification Requirements for New York - Effective 6/1/2015 (PDF 224.27 KB)

Advanced Notification Requirements for New York - Effective 10/1/ 2014 (PDF 247.1 KB)

CPT (Current Procedural Terminology) Codes

Radiology Crosswalk Table (PDF 934.25 KB)
Radiology Prior Authorization List - Medicaid (PDF 304.09 KB)
Radiology Prior Authorization List - Dual Advantage (PDF 301.61 KB)

 

 

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.