Provider forms and references
Quick reference guides
- UnitedHealthcare Community Plan of New Jersey quick reference guide
- Behavioral Health quick reference guide
- Dental quick reference guide
- Home and Community Based Services (HCBS) quick reference guide
- Housing Services, Supports and Assistance quick reference guide
- MLTSS nutritional supports quick reference guide
Reference guides
- Doula: Submitting claims and member eligibility
- Enhancing elderly care: Fall risk screening in primary care
- Family Guide to Autism Services - Chinese
- Family Guide to Autism Services - English
- Family Guide to Autism Services - Hindu
- Family Guide to Autism Services - Portuguese
- Family Guide to Autism Services - Spanish
- Family Guide to Autism Services - Tadjik
- Lead screening quick reference guide
- Leading the Way on Lead
- National drug codes requirement for claims submissions
- UnitedHealthcare Community Plan of New Jersey appointment availability and after-hours standards
- Verifying benefits and billing guidelines for New Jersey network health care providers
Provider forms
- Critical incident reporting form
- DOBI Claims Appeal form
- Entity Disclosure of Ownership and Control Interest form (online version)
- Health care professional — special needs survey form
- Hysterectomy and Sterilization Procedures and Consent form
- Individual Disclosure of Ownership and Control Interest form (online version)
- Long-term care and housing supports prior authorization request form
- Medication-assisted treatment and office-based addictions treatment questionnaire and attestation form
- Prior authorization forms
- Provider data verification for New Jersey
- Provider Disclosure of Ownership and Control Interest Statement form FAQ
- Specialist referral form
- Verbal risk assessment for lead toxicity
Submit a pre-service appeal and/or grievance for a Medicaid member