UnitedHealthcare Community Plan
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UnitedHealthcare Community Plan Delaware Providers

Welcome to the UnitedHealthcare Community Plan Health Professionals area for Delaware providers!

Here you will find the information, forms, manuals and links you need to conduct business with UnitedHealthcare Community Plan.

Attention Providers: Some phone numbers for UHC staff members have changed. Click "Contact Us" for the updated information.

Manuals and Forms

Click on the arrow above to view manuals and forms. 

Provider Education

Click on the arrow above to view provider educational materials.

Medical Injectables

Click on the arrow above to view information on medical injectables.

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.

Helpful Links & Information

Click on the arrow above to view additional links and information.

Health Plan NCQA AccreditationUnitedHealthcare Community Plan received NCQA New Health Plan Accreditation on July 7, 2010. NCQA's mission is to improve the quality of health care, and participating in their accreditation process is voluntary. NCQA’s New Health Plan Accreditation Program applies to health plans that are less than 36 months old. The program is distinct from NCQA's MCO Accreditation Program. NCQA Accreditation is a nationally recognized evaluation that purchasers, regulators, and consumers can use to assess managed care plans.

Prior Authorization Archive

Click on the arrow above to view the prior authorization archive.

UnitedHealthcare Community Plan Prior Authorization DE CAID CHIP - Effective 4/1/2017 (PDF 265.39 KB)

UnitedHealthcare Community Plan Prior Authorization DE LTC - Effective 4/1/2017 (PDF 245.47 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 DE CAID CHIP - Effective 1/1/2017 (PDF 252.94 KB)

UnitedHealthcare Community Plan Prior Authorization DE LTC - Effective 1/1/2017 (PDF 227.87 KB)

UnitedHealthcare Community Plan Prior Authorization DE CAID CHIP - Effective 10/1/2016 (PDF 253.63 KB)

UnitedHealthcare Community Plan Prior Authorization DE LTC - Effective 10/1/2016 (PDF 237.67 KB)

UnitedHealthcare Community Plan Prior Authorization DE LTC - Effective 7/1/2016 (PDF 206.59 KB)

UnitedHealthcare Community Plan Prior Authorization DE CAID/CHIP - Effective 7/1/2016 (PDF 210.01 KB)

UnitedHealthcare Community Plan Prior Authorization DE - Effective 5/1/2016 (PDF 201.1 KB)

UnitedHealthcare Community Plan Prior Authorization DE - Effective 1/1/2016 (PDF 222.71 KB)

Prior Authorization (PDF 221.84 KB) - Effective December 7, 2015

Advanced Notification Requirements for Delaware - Effective June 1, 2015 (PDF 217.82 KB)

Advanced Notification Requirements for Delaware  - Effective Oct. 1, 2014 (PDF 260.49 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.