Transcription
2022Care Provider ManualPhysician, Health Care Professional, Facility and AncillaryHawai’i QUEST IntegrationDoc#: PCA-1--016683-12222021 01052022v63.10.2021
WelcomeWelcome to the UnitedHealthcare Community Planprovider manual. This up-to-date reference manualallows you and your staff to find important informationsuch as how to process a claim and prior authorization.This manual also includes important phone numbersand websites on the How to Contact Us page. Findoperational policy changes and other electronictransactions on our website at UHCprovider.com.Click the following links to access differentmanuals: UnitedHealthcare Administrative Guide forCommercial and Medicare Advantage memberinformation. Some states may also have MedicareAdvantage information in their Community Planmanual. A different Community Plan manual: go toUHCprovider.com. Click Menu on top left,select Administrative Guides and Manuals, thenCommunity Plan Care Provider Manuals, selectstate.Easily find information in this manual usingthe following steps:1. Select CTRL F.2. Type in the key word.3. Press Enter.If available, use the binoculars icon on the top right handside of the PDF to search for information and topics. Wegreatly appreciate your participation in our program andthe care you offer our members.I f you have questions about the informationor material in this manual, or about ourpolicies, please call Provider Services.2 UnitedHealthcare Community Plan of Hawaii v 61.7.2021 Important informationabout the use of this manualIf there is a conflict between your Agreement and thiscare provider manual, use this manual unless yourAgreement states you should use it, instead. If there isa conflict between your Agreement, this manual andapplicable federal and state statutes and regulationsand/or state contracts, applicable federal and statestatutes and regulations and/or state contracts willcontrol. UnitedHealthcare Community Plan reservesthe right to supplement this manual to help ensure itsterms and conditions remain in compliance with relevantfederal and state statutes and regulations.This manual will be amended as policies change.Terms and definitions as used in this manual: “Member” or “customer” refers to a person eligibleand enrolled to receive coverage from a payer forcovered services as defined or referenced in yourAgreement. “You,” “your” or “provider” refers to any healthcare provider subject to this manual, includingphysicians, health care professionals, facilities andancillary providers; except when indicated andall items are applicable to all types of health careproviders subject to this manual. “Community Plan” refers to UnitedHealthcare’sMedicaid plan. “Your Agreement,” “Provider Agreement” or“Agreement” refers to your Participation Agreementwith us. “Us,” “we” or “our” refers to UnitedHealthcareCommunity Plan on behalf of itself and its otheraffiliates for those products and services subject tothis guide. Any reference to “ID card” includes both a physicalor digital card. 2021 UnitedHealthcare
WelcomeOverview of the QUESTIntegration Programand UnitedHealthcareCommunity PlanQUEST Integration is the State of Hawai’i’s managedcare Medicaid program. It brings together into a singleprogram previous Medicaid programs such as QUEST,QUEST Expanded Access (QExA), QUEST-ACE andQUEST-Net as well as Medicaid Expansion under theAffordable Care Act (ACA). The program includespersons eligible for Medicaid and Children’s HealthInsurance Program (CHIP).Integrated careIntegrated care is based on a clinical model that directscare between medical and behavioral health providers.It began with the Collaboration of Care (CoC) clinicalmodel, which introduced behavioral health in a primarycare setting. With integrated care, care providers treatmembers with a shared care plan using telemedicine,clinical rounds, co-location, joint sessions or othermethods.We have clinical transformation consultants tosupport you in our journey to full integration. For moreinformation on integrated care training, please visitUHCprovider.com/IntegratedCare.The goals of the State of Hawai‘i and UnitedHealthcareCommunity Plan are to: Improve the health status of the QUEST Integrationmember population Minimize administrative burdens, streamline accessto care for members with changing health status,and improve healthcare outcomes by integratingprograms and benefits Align the program with the Affordable Care Act(ACA) Improve care coordination by establishing a“provider/medical home” for members through theuse of assigned primary care providers (PCPs) Expand access to home and community basedservices (HCBS) and allow members to have achoice between institutional services and HCBS Maintain a managed care delivery system thatassures access to high quality, cost-effective carethat is provided whenever possible, in the member’scommunity, for all covered populations Establish contractual accountability among theState, UnitedHealthcare Community Plan, andproviders Develop a program that is fiscally predictable,stable, and sustainable over time Expand and strengthen a sense of memberresponsibility and promote independence andchoice among members that leads to a moreappropriate utilization of the health care system Develop a program that places maximum emphasison the efficacy of services and offers health plansboth incentives for quality and sanctions for failureto meet measurable performance goals.3 UnitedHealthcare Community Plan of Hawaii v 61.7.2021 2021 UnitedHealthcare
Table of Contents5Chapter 1: IntroductionChapter 2: Care Provider Standards and Policies16Chapter 3: Care Provider Office Procedures25Chapter 4: Medical Management29Chapter 5: Early, Periodic Screening, Diagnosis and Treatment (EPSDT)/Prevention49Chapter 6: Benefits - Covered, Excluded and Value-Added52Chapter 7: Mental Health and Substance Use82Chapter 8: Member Rights and Responsibilities86Chapter 9: Member Records89Chapter 10: Quality Management (QM) Program and Compliance Information93Chapter 11: Billing and Submission100Chapter 12: Claim Reconsiderations, Appeals and Grievances108Chapter 13: Provider Communications andOutreach119Glossary1214 UnitedHealthcare Community Plan of Hawaii v 61.7.2021 2021 UnitedHealthcare
Chapter 1: IntroductionKey contactsTopicProvider ServicesTrainingProvider PortalCommunityCare ProviderPortal SupportProvider Portal TrainingResource UHCprovider.com, then Sign In using your One Healthcare ID or goto Provider Portal Self Service: elf-service.htmlNew users: UHCprovider.com New User and User Accessprovidertechsupport@uhc.comPhone 5909CommunityCare Provider Portal User GuideUHCprovider.com Menu Resource LibraryLooking for something else? In PDF view, click CTRL F, then type the keyword. In web view, type your keyword in the “what can we help you find?” search bar.UnitedHealthcare Community Plan provides benefits andservice to members, including: TANF – Temporary Assistance for Needy Families CHIP – Children’s Health Insurance Program AABD – Assistance to the Aged, Blind, and Disabled LTC – Long-term Care DSNP – Dual Special Needs PlanIf you have questions about theinformation in this manual or about ourpolicies, go to UHCprovider.com or callProvider Services at 888-980-8728.How to join our networkThe Hawaii Department of Human Services (DHS)/Med-QUEST Division (MQD) requires all care providerswho serve QUEST members to register with the newMed-QUEST Division provider enrollment system, HOKU.HOKU is a web-based system that lets you register asa Medicaid provider. Find more information and HOKUresources at medquest.hawaii.gov/hoku.Already in network and need to make achange?To change an address, phone number, addor remove physicians from your TIN, orother changes, email hawaii networkmanagement@uhc.com.For instructions on joining theUnitedHealthcare Community Planprovider network, go to UHCprovider.com.There you will find guidance on ourcredentialing process, how to sign up foronline tools and other helpful information.5 UnitedHealthcare Community Plan of Hawaii v 61.7.2021 2021 UnitedHealthcare
Chapter 1: IntroductionOur approach to health careCare ModelThe Care Model program seeks to empowerUnitedHealthcare Community Plan members enrolled inMedicaid, care providers and our community partnersto improve care coordination and elevate outcomes.Targeting UnitedHealthcare Community Plan members withchronic complex conditions who often use health care, theprogram helps address their needs holistically. Care Modelexamines medical, behavioral and social/environmentalconcerns to help members get the right care from the rightcare provider in the right place and at the right time.The program provides interventions to memberswith complex medical, behavioral, social, pharmacyand specialty needs, resulting in better quality of life,improved access to health care and reduced expenses.Care Model provides a care management/coordinationteam that helps increase member engagement, offersresources to fill gaps in care and develops personalizedhealth goals using evidence-based clinical guidelines.This approach is essential to improving the health andwell-being of the individuals, families and communitiesUnitedHealthcare Community Plan serves. Care Modelprovides: Market-specific care management encompassingmedical, behavioral and social care. An extended care team including primary careprovider (PCP), pharmacist, medical and behavioraldirector, and peer specialist. Options that engage members, connecting them toneeded resources, care and services. Individualized and multidisciplinary care plans. Assistance with appointments with PCP andcoordinating appointments. The memberadvocates refer member for health coordinationwith a registered nurse or social worker, behavioralhealth advocate or other specialists as required forcomplex needs. Education and support with complex conditions.The Care Model program goals are to: Lower avoidable admissions and unnecessaryemergency room (ER) visits, measured outcomes byinpatient (IP) admission and ER rates. Improve access to PCP and other needed services,measured by number of PCP visit rates withinidentified time frames. Identify and discuss behavioral health (BH) needs,measured by number of BH care provider visitswithin identified time frames. Match our members’ dynamic needs with the mostappropriate treatment available to address theirbehavioral health care needs through seamlesstransitions in care adjusted based on their currentclinical status. Help ensure behavioral health treatment is based onclear medical necessity criteria, is flexible enoughto meet members’ clinical needs and is coordinatedacross the service array without disrupting membercare or outcomes. Improve access to pharmacy. Identify and remove social and environmentalbarriers to care. Improve health outcomes, measured by improvedHealth Plan Employer Data and Information Set(HEDIS ) and Centers for Medicare & MedicaidServices (CMS) Star Ratings metrics. Empower the member to manage their complex/chronic illness or problem and care transitions. Improve coordination of care through dedicated staffresources and to meet unique needs. Engage community care and care provider networksto help ensure access to affordable care and theappropriate use of services.To refer your patient who is aUnitedHealthcare Community Planmember to Care Model, call ProviderServices at 888-980-8728. Tools for helping members engage with providers,such as appointment reminders and help withtransportation.Complementary andalternative healing practices Foundation to build trust and relationships with hardto-engage members.Many cultures engage in traditional health practicessuch as holistic medicine, acupuncture, medicinal herbs,6 UnitedHealthcare Community Plan of Hawaii v 61.7.2021 2021 UnitedHealthcare
Chapter 1: Introductionmeditation, spiritual counseling, therapeutic massage ormartial arts.When developing a treatment plan for members, consider: Asking the member if they take any treatments,medicines or herbs to help them stay healthy or astreatment for their condition Inquiring whether the member has sought advice ortreatment from friends, alternative healers or otherpractitioners Acknowledging the member’s choice forconsultation of spiritual or traditional practitionersin addition to prescribing more western forms oftreatmentComplianceHIPAA mandates National Provider Identifier (NPI)usage in all standard transactions (claims, eligibility,remittance advice, claims status request/response,and authorization request/response) for all health careproviders who handle business electronically.Cultural resourcesTo help you meet membership needs, UnitedHealthcareCommunity Plan has developed a Cultural CompetencyProgram. Linguistic and cultural barriers can negativelyaffect access to health care participation. You mustsupport UnitedHealthcare Community Plan’s CulturalCompetency Program. For Cultural Competency trainingvisit UHCprovider.com/training.UnitedHealthcare Community Plan offers the followingsupport services: Language Interpretation Line: Hawai‘i is the onlystate in the United States that has designated anative language, Hawai’ian, as one of its two officialstate languages. To support this, we provide anytimeoral interpreter services to our members free ofcharge. More than 250 non-English languagesand hearing impaired services are available. If aUnitedHealthcare Community Plan member needsinterpreter services, they can call the phone numberon their ID card.- If you need a professional interpreter duringregular business hours, call Provider Services at888-980-8728. After hours, call 877-261-6608. Sign Language Interpretation: We provide signlanguage interpreters for our members. Please callProvider Services at 888-980-8728.7 UnitedHealthcare Community Plan of Hawaii v 61.7.2021 Materials for limited-English speaking members:We provide simplified materials for memberswith limited English proficiency and who speaklanguages other than English or Spanish. We alsoprovide materials for visually impaired members.For more information, go to tancenotices.Evidence-based clinicalreview criteria andguidelinesUnitedHealthcare Community Plan uses Interqual formedical care determinations. We used to use MCG.Online resourcesUHCprovider.com is your home for care providerinformation with access to Electronic Data Interchange(EDI), Provider Portal online tools, medical policies, newsbulletins, and great resources to support administrativetasks including eligibility, claims, claims status andprior authorizations and notifications. Go to Self ServiceFor Self Service Tool online training and information rself-service.html.Electronic Data Interchange (EDI)EDI is an online resource using your internal practicemanagement or hospital information system to exchangetransactions with us through a clearinghouse. Thebenefit of using EDI is it permits care providers to sendbatch transactions for multiple members and multiplepayers in lieu of logging into different payer websites tomanually request information. This is why EDI is usuallycare providers’ first choice for electronic transactions. Send and receive information faster. Identify submission errors immediately and avoidprocessing delays. Exchange information with multiple payers Reduce paper, postal costs and mail time Cut administrative expenses EDI transactions available to care providers are:- Claims (837),- Eligibility and benefits (270/271), 2021 UnitedHealthcare
Chapter 1: Introduction- Claims status (276/277),- Referrals and authorizations (278),- Hospital admission notifications (278N), and- Electronic remittance advice (ERA/835).Visit UHCprovider.com/EDI for more information. Learnhow to optimize your use of EDI at UHCprovider.com/optimizeEDI.5reasonsto useUHCprovider.comGetting startedIf you have a practice management or hospitalinformation system, contact your software vendor forinstructions on how to use EDI in your system.Contact clearinghouses to review which electronictransactions can interact with your software system. VisitUHCprovider.com/EDI EDI Clearinghouse Options formore information.Provider Portal - secure care providerwebsiteProvider Portal provides a secure online portal tosupport your administrative tasks including eligibility,claims and prior authorization and notifications. Tosign in to Provider Portal, go to UHCprovider.com andclick on the sign in button in the upper right corner.For more information about the online services, go toUHCprovider.com and sign in. Or go to Self ServiceTools and Eligibility. For Provider Portal training, go toCommunityCare Provider Portal User Guide. The first time you sign into the portal,you’ll need to create a One HealthcareID. You will receive your user ID andpassword within 48 hours.The secure care provider website lets you: Verify member eligibility including secondarycoverage. Review benefits and coverage limits. Check prior authorization status. Access remittance advice and review recoveries.1Provider PortalPriorAuthorizationand NotificationClick “Sign In” in the top rightcorner of UHCprovider.com23Request approval forprescriptions, admissionsand procedures.UHCprovider.com/paanSend batch transactionsfor multiple members andpayers from one place,review claims and onnect5Policiesand ProtocolsUse self-service to verifyeligibility and claims, requestprior authorization, providenotifications and accessDocument Library.Communicate securelywith payers to addresserrant claims. Emaildirectconnectsupport@optum.com to get started.Review guidelines thatapply to UnitedHealthcareCommunity Plan andhow you care for ourmembers.UHCprovider.com/policiesFind more information about these online services and moreat UHCprovider.com – your hub for online transactions,education and member benefit information. Review your preventive health measure report. Access the Early and Periodic Screening, Diagnosis,and Treatment (EPSDT) toolset.8 UnitedHealthcare Community Plan of Hawaii v 61.7.2021 2021 UnitedHealthcare
Chapter 1: Introduction Search for CPT codes. Type the CPT code inthe header search box titled “what can we helpyou find?” on UHCprovider.com, and the searchresults will display all documents and/or web pagescontaining that code. Find certain web pages more quickly usingvanity URLs. You’ll see changes in the way wedirect you to specific web pages on ourUHCprovider.com provider portal. You can nowuse certain vanity URLs, which helps you find andremember specific web pages easily and quickly.You can access our most used and popular webpages on UHCprovider.com by typing in that page’svanity URL identified by a forward slash in the webaddress, e.g. UHCprovider.com/claims. When yousee that forward slash in our web links, you cancopy the vanity URL into your web page address barto quickly access that page.You will conduct business with us electronically. Usingelectronic transactions is fast, efficient, and supportsa paperless work environment. Use both EDI and theProvider Portal for maximum efficiency in conductingbusiness electronically. To access the portal, go toUHCprovider.com and sign in.Here are most frequently used transactions: Eligibility and Benefits — View patient eligibilityand benefits information for most benefit plans.Go to UHCprovider.com, then sign in or go toUHCprovider.com/eligibility Eligibility Tool. Claims — Get claims information for manyUnitedHealthcare plans, including access letters,remittance advice documents and reimbursementpolicies. Go to UHCprovider.com, then sign in or goto UHCprovider.com/claims Claims Tool. Prior Authorization and Notification — Submitnotification and prior authorization requests. Formore information, go to UHCprovider.com/paan. Specialty Pharmacy Transactions — Submitnotification and prior authorization requests forcertain medical injectable specialty drugs. Go toUHCprovider.com/pharmacy for more information. Provider Demographics — View your providerdemographic data that UnitedHealthcare memberssee for your practice. For more information, goto UHCprovider.com/mypracticeprofile. Emaildemographic updates to hawaii networkmanagement@uhc.com.9 UnitedHealthcare Community Plan of Hawaii v 61.7.2021 Document Library — Access reports and claimletters for viewing, printing, or download. TheDocument Library Roster provides member contactinformation in a PDF, and can only be pulled at theindividual practitioner level. For more information, goto UHCprovider.com/documentlibrary. Paperless Delivery Options — The PaperlessDelivery Options tool can send daily or weekly emailnotifications to alert you to new letters when we addthem to your Document Library. With our deliveryoptions, you decide when and where the emailsare sent for each type of letter. This is available toProvider Portal password owners only.You need a One Healthcare ID to access the portaland use tools available to you. To register for a OneHealthcare ID, go to UHCprovider.com/newuser.Watch for the most current information on our selfservice resources by email, in the Network Bulletin, oronline at UHCprovider.com/EDI or the Provider Portalat UHCprovider.com and sign in.For more instructions, visit UHCprovider.com/Trainingor Self Service Tools for online self- service training andinformation.Direct ConnectDirect Connect is a free online tool on our portal that letsyou securely communicate with payers to address errantclaims. This portal can replace previous methods ofletters, phone calls and spreadsheets. It also helps: Manage overpayments in a controlled process. Create a transparent view between care providerand payer. Avoid duplicate recoupment and returned checks. Decrease resolution timeframes. Real-time reporting to track statuses of inventories inresolution process. Provide control over financial resolution methods.All users will access Direct Connect using our portal.On-site and online training is available.Email directconnectsupport@optum.comto get started with Direct Connect. 2021 UnitedHealthcare
Chapter 1: IntroductionPrivilegesTo help our members access appropriate care andminimize out-of-pocket costs, you must have privilegesat applicable in-network facilities or arrangements withan in-network provider to admit and provide facilityservices. This includes full admitting hospital privileges,ambulatory surgery center privileges and/or dialysiscenter privileges.Provider ServicesProvider Services is the primary contact for careproviders who require assistance. It is staffed withrepresentatives trained specifically for UnitedHealthcareCommunity Plan.Provider Services can assist you withquestions on Medicaid benefits, eligibility,claim decision, forms required to reportspecific services, billing questions andmore.Provider Services works closely with all departments inUnitedHealthcare Community Plan.How to contact us*We no longer use fax numbers for most departments, includingbenefits, prior authorization and claims.10 UnitedHealthcare Community Plan of Hawaii v 61.7.2021 2021 UnitedHealthcare
Chapter 1: ffice1132 Bishop St., Suite 400Honolulu, HI 96813Open 7:45 a.m. to 4:30 p.m. Hawai’i StandardTime (HST) Monday through FridayNOTE: Please do not submit claims to thisaddress. Use the claims address listedbelow under Claims.888-980-8728TTY: 711 (Hearing Impaired)Behavioral 2-8054 (MA-DSNP)Mailing Address:OptumP.O. Box 30757Salt Lake City, UT 84130-0757Payer ID: 87726Behavioral HealthClaim Disputes888-980-8728Ask about behavioral claim disputes.BenefitsUHCprovider.com/benefitsConfirm a member’s benefits and/or priorauthorization.888-980-8728Cardiology PriorAuthorizationFor prior authorization or a currentlist of CPT codes that require priorauthorization, visit UHCprovider.com/hicommunityplan Prior Authorizationand Notification.Review or request prior authorization, see basicrequirements, guidelines, CPT code list, andmore information.866-889-8054Care Model888-980-872811 UnitedHealthcare Community Plan of Hawaii v 61.7.2021 Refer high-risk members (e.g., asthma, diabetes)and members who need private-duty nursing. 2021 UnitedHealthcare
Chapter 1: IntroductionTopicContactInformationClaimsSign in to the Provider Portal atUHCprovider.com or go to UHCprovider.com/claims for more information.Ask about a claim status or about propercompletion or submission of claims.888-980-8728Mailing address:UnitedHealthcare Community PlanQUEST IntegrationP.O. Box 31365Salt Lake City, UT 84131-0365Payer ID#: 87726 (EDI Claims Submission)Payer ID# 04567 (ERA use)ClaimOverpaymentsSee the Overpayment section forrequirements before sending yourrequest.Ask about claim overpayments.Go to UHCprovider.com/claims. Or go toUHCprovider.com and sign in.888-980-8728Mailing address:UnitedHealthcare Community PlanATTN: Recovery ServicesP.O. Box 740804Atlanta, GA 30374-0800Electronic DataIntake Claim Issuesac edi ops@uhc.comAsk about claims issues or questions.800-210-8315Electronic Data800-842-1109Intake Log-on IssuesInformation is also available at UHCprovider.com.EligibilityConfirm member eligibility.To access eligibility information, go toUHCprovider.com then Sign In to theProvider Portal or go to UHCprovider.com/eligibility888-980-8728Fraud and Abuse(Payment Integrity)Payment Integrity Information:Learn about our payment integrity policies.website: UHCprovider.com/HIcommunityplan Integrity of Claims,Reports, and Representations to theGovernment.Report suspected FWA by a care provider ormember by phone or online.Reporting: uhc.com/fraud800-455-4521 or 877-401-943012 UnitedHealthcare Community Plan of Hawaii v 61.7.2021 2021 UnitedHealthcare
Chapter 1: IntroductionTopicContactInformationLaboratory ServicesUHCprovider.com Find Dr PreferredLab NetworkLabCorp and Quest Diagnostics are networklaboratories.LabCorp: 800-833-3984Quest DiagnosticsMedicaid[Department ofSocial Services]Medicaid.govContact Medicaid directly.Department of Human Services:(Oahu)808-524-3370TTY/TDD #: 808-692-7182(Neighbor Islands)800-316-8005TTY/TDD #: 800-603-1201Website: medquest.hawaii.govMedical ClaimDisputesSign in to the Provider Portal atUHCprovider.com or go to UHCprovider.com/claims for more information.888-980-8728Claim issues include overpayment,underpayment, payment denial, or an original orcorrected claim determination you don’t agreewith.Reconsiderations mailing address:UnitedHealthcare Community PlanP.O. Box 31350Salt Lake City, UT 84131-0365Appeals mailing address:Community Plan Grievancesand Appeals1132 Bishop Street Suite 400Honolulu, HI 96813Member Servicesmyuhc.com888-980-8728/TTY 711Technical help 877-542-9239Assist members with issues or concerns.Available 7:45 a.m. to 4:30 p.m. HT Mondaythrough Friday.Multilingual/TelecommunicationDevice for the Deaf(TDD) Services888-980-8728 or TTY 711 forhearing impairedAvailable 7:45 a.m. – 4:30 p.m. HT, Mondaythrough Friday, except state-designated holidays.National Planand ProviderEnumerationSystem (NPPES)nppes.cms.hhs.govApply for a National Provider Identifier (NPI).NurseLine888-980-8728 or TTY 711 forhearing impaired800-465-320313 UnitedHealthcare Community Plan of Hawaii v 61.7.2021 Available at any time. 2021 UnitedHealthcare
Chapter 1: IntroductionTopicContactInformationObstetrics andBaby Care (HāpaiMālama)Sign in to the Provider Portal atUHCprovider.com or go to UHCprovider.com/claims for more information.Refer pregnant women to the Hāpai Mālamaprogram.888-980-8728 (TTY users: 711)One Healthcare IDSupport CenterProviderTechSupport@uhc.comPharmacy ServicesUHCprovider.com/hicommunityplan Pharmacy Resources and PhysicianAdministered Drugs855-819-5909877-305-8952 (OptumRx and Mail Order)844-568-2147 (Pharmacy Help Desk pharmacies only)855-427-4682 (Optum SpecialtyPharmacy)Prior Authorization/Notification forPharmacyUHCprovider.com Prior Authorizationand Notification Clinical Pharmacy andSpecialty DrugsTo notify UnitedHealthcare of pregnant patientsdigitally and reduce paperwork, you can also useCare Conductor and Notification on our portal.Contact if you have issues with your ID. Available3 a.m - 5 p.m HT, Monday - Friday: 2 a.m - 2 p.mHT, Saturday: 5 a.m. - 2 p.m. HTOptumRx oversees and manages our networkpharmacies.Use Provider Portal to access the PreCheckMyScript tool. Request prior authorization andreceive results, and see which prescriptionsrequire prior authorization or are not covered orpreferred. Check coverage and price, includinglower-cost alternatives.Request authorization for medications asrequired.800-310-6826covermymeds.comPrior AuthorizationRequests andAdvance AdmissionNotificationsTo notify us or request a medical priorauthorization:EDI: Transactions 278 and 278NOnline Tool: UHCprovider.com/paanPhone: Call Care Coordination at thenumber on the member’s ID card (onlinesolutions available after hours) and select“Care Notifications.” Or call 888-980-8728.Use the Prior Authorization and Notification Toolonline to: Determine if notification or prior authorizationis required. Complete the notification or priorauthorization process. Upload medical notes or attachments. Check request statusInformation and advance notification/priorauthorization lists: Visit UHCprovider.com/HIcommunityplan Prior Authorization andNotificationProvider Services888-980-8728For Medicare Advantage-Dual SpecialNeeds Program (MA-DSNP):866-622-8054Radiology PriorAuthorizationUHCprovider.com/hicommunityplan Prior Authorization and Notification866-889-805414 United
UnitedHealthcare Community Plan members enrolled in Medicaid, care providers and our community partners to improve care coordination and elevate outcomes. Targeting UnitedHealthcare Community Plan members with chronic complex conditions who often use health care, the p
