CommunityCare

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The best way for primary care providers (PCPs) to view and export the full member roster is using the CommunityCare feature on the UnitedHealthcare Provider Portal, which allows you to:  

• Identify Medicaid recipients who need to have their Medicaid recertification completed and approved by the state in order to remain eligible to receive Medicaid benefits
• See a complete list of all members, or just members added in the last 30 days
• Export the roster
• View most Medicaid and Medicare Special Needs Plans (SNP) members’ plans of care and health assessments
• Enter plan notes and view notes history (for some plans)
• Obtain HEDIS information for your member population
• Access information about members admitted to or discharged from an inpatient facility
• Access information about members seen in an emergency department

For help using CommunityCare feature on the UnitedHealthcare Provider Portal, please see our Quick Reference Guide. If you’re not familiar with UnitedHealthcare Provider Portal, visit our Portal Resources page.

Chat

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Questions? We're here to help.

Connect with us through chat 24/7 in the UnitedHealthcare Provider Portal.

UHC Assisted Living - Header

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UHC Care Advantage plans are Institutional-Equivalent Special Needs Plans (IE-SNPs) for members who reside in assisted living facilities within the community and require an institutional level of care. These plans do not require referrals for specialty care.

• UHC Care Advantage (HMO-POS I-SNP)
• UHC Care Advantage (PPO I-SNP)

Chat + Provider Services

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Questions? We're here to help.

Connect with us through chat 24/7 in the UnitedHealthcare Provider Portal.

GEHA

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More information coming soon.

HIPAA and disclaimer text on community plan pages

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Health Insurance Portability and Accountability Act (HIPAA) information

HIPAA standardized both medical and non-medical codes across the health care industry and under this federal regulation, local medical service codes must now be replaced with the appropriate Healthcare Common Procedure Coding System (HCPCS) and CPT-4 codes.

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. 

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.

Additional Plan Information

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To learn more about the Medicare Advantage plans offered in your area, visit UHC.com/medicare and enter your ZIP code.

Medicare Part D Information

To learn more about Medicare Part D prescription drug coverage or to access related forms, review the materials available on the Plan Information and Forms page of UHC.com/medicare.

AARP MedComp Referral - Header

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AARP Medicare Advantage from UHC plans cover features and benefits in addition to those included in Original Medicare. Members in some areas may have different plans from which to choose. The plans often include an integrated Medicare Part D prescription drug benefit.

Choice Advanced

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UnitedHealthcare Choice Advanced health plans allow members to choose a physician or specialist in the UnitedHealthcare Choice networks and do not need a primary care physician or referral to receive benefits. There is out-of-network coverage for emergency services only.

• UnitedHealthcare Choice Advanced members must receive care from network care providers for benefits to be covered. Members are encouraged to choose lower cost, freestanding network health care facilities rather than hospitals for radiology services and outpatient surgery.
• UnitedHealthcare Choice Advanced Plus members are encouraged to seek care from the network care providers but don’t need a referral to receive benefits; members are covered for out-of-network care provider visits at a lower benefit level.

UnitedHealthcare Choice Advanced members have lower copays and/or greater coinsurance when they use Tier 1 UnitedHealth Premium® Care Physicians.

UnitedHealthcare Choice Advanced and UnitedHealthcare Choice Advanced Plus build on Choice and Choice Plus plans with additional features for both members and employers.

Paperless

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Questions? We’re here to help.

Connect with us through chat 24/7 in the UnitedHealthcare Provider Portal.

Portal Help Desk

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UnitedHealthcare Provider Portal support

Connect with us 24/7 to get help with portal login, access and functionality questions. To get started, sign in to the portal with your One Healthcare ID. Then, select the chat icon at the bottom-right corner of the page. Support is also available by calling 866-842-3278, option 1.

Surest (formerly Bind)

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Surest is a UnitedHealthcare company that administers health plans without deductibles or coinsurance. Members have access to the nationwide UnitedHealthcare and Optum^® Behavioral Health networks and can check costs and care options in advance.

If you participate in UnitedHealthcare commercial plans, you automatically participate in Surest benefit plans at the existing commercial reimbursement rates per your participation agreement.

A small number of members have the Surest Flex plan, which includes the feature of flexible coverage. For a fixed list of plannable tests, procedures or treatments, the member must activate coverage at least 3 business days in advance of the service, or the member may not have coverage for the service.

Claims: Please send claims to us electronically using Surest Payer ID 25463 or by mail to Surest, P.O. Box 211758, Eagan, MN 55121. Include the subscriber ID and rendering address on the claim to help us confirm the copay/member price. Check the status of your claims in the UnitedHealthcare Provider Portal.

Eligibility and benefits: To check member eligibility and benefits, visit the provider portal or call Surest Provider Services at 844-368-6661. If you’re requesting information about a dependent, we’ll need the subscriber ID.

Variable copays: You can receive variable copay information through electronic data interchange (EDI) 270/1 transaction responses. For more information, see the 270/271 EDI Surest guide and Digital Solutions page.

For more information, please visit UHCprovider.com/surest.

Prior Authorization tool access

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How to access the Prior Authorization and Notification tool

To manage existing or submit new prior authorizations, please sign in through the UnitedHealthcare Provider Portal. From the left-hand tabs, select Prior Authorizations & Notifications to get started.

Questions version 2

Chat with a live advocate 7 a.m.–7 p.m. CT from the UnitedHealthcare Provider Portal Contact Us page.

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Questions? We’re here to help.

Connect with us through chat 24/7 in the UnitedHealthcare Provider Portal.

Prior Authorization

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How to submit and manage prior authorizations

• Sign in to the UnitedHealthcare Provider Portal with your One Healthcare ID
  • If you don’t have a One Healthcare ID, register now
• From the left-hand tabs, select Prior Authorizations & Notifications
   

For training, view our Prior Authorization and Notification interactive guide.

UHC Assisted Living - Main

Tag with "UHC Assisted Living" to show with UnitedHealthcare® Assisted Living Plan in CO,CT,FL,MD,NC,OH,OR,RI,WA,WI

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Health Maintenance Organization (HMO) plans have a defined network of contracted local physicians and hospitals to provide member care. Generally, members must use these care providers to receive benefits for covered services, except in emergencies.

Point of Service (HMO-POS) plans include all the features of HMO plans plus the ability to go outside the contracted network for certain health care services - typically at a higher cost. Some POS plans only cover out-of-network dental care.

Preferred Provider Organization (PPO) plans work with a network of contracted local physicians and hospitals, but also allows members the flexibility to seek covered services from outside of the contracted network, usually at a higher cost.

UnitedHealthcare offers Medicare Advantage Special Needs Plans (SNPs) that combine the hospital and doctor coverage of Medicare Parts A and B with Part D prescription drug coverage, plus additional benefits and services designed to meet the unique needs of identified Medicare consumer populations.

UHC Nursing - Main

Tag with "UHC Nursing" to show with UnitedHealthcare® Nursing Home Plan in AL,AZ,CO,CT,DE,FL,GA,IL,IN,ME,MD,MA,MN,MO,NH,NJ,NY,NC,OH,OR,PA,RI,SC,TX,VA,WA,WI

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Health Maintenance Organization (HMO) plans have a defined network of contracted physicians and hospitals to provide member care. Generally, members must use these providers to receive benefits for covered services, except in emergencies.

Point of Service (HMO-POS) plans include all the features of HMO plans plus the ability to go outside the contracted network for certain health care services - typically at a higher cost. Some POS plans only cover out-of-network dental care.

Preferred Provider Organization (PPO) plans offer members access to a network of contracted physicians and hospitals, but also allow them the flexibility to seek covered services from outside of the contracted network, usually at a higher cost.

UnitedHealthcare offers Medicare Advantage Special Needs Plans (SNPs) that combine the hospital and doctor coverage of Medicare Parts A and B with Part D prescription drug coverage, plus additional benefits and services designed to meet the unique needs of identified Medicare consumer populations.

Erickson Champ Guard

Erickson Advantage® Champion/Guardian Plans, tag with Erickson Champ Guard. Shows in CO,KS,MD,MA,MI,NJ,NC,PA,TX,VA

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Medicare Advantage Special Needs Plans (SNPs) insured through UnitedHealthcare are offered to residents of Erickson Retirement Communities. These SNP plans combine the hospital and doctor coverage of Medicare Parts A and B with Part D prescription drug coverage, plus additional benefits and services designed to meet the unique needs of identified Medicare consumer populations. These plans do not require referrals for specialty care.

Erickson Advantage Champion (HMO-POS C-SNP) is a Medicare Advantage Chronic Condition SNP that provides specialized benefits and services for Medicare beneficiaries with chronic conditions such as diabetes, heart failure and/or cardiovascular disorders. Members choose their primary care provider (PCP) and may go outside the covered network for covered health care services - typically at a higher cost.

Erickson Advantage Guardian (HMO-POS I-SNP) is a Medicare Advantage Institutional SNP that provides specialized benefits and services for Medicare beneficiaries who live in an Erickson nursing home. Members choose their primary care provider (PCP) and may go outside the contracted network for covered health care services - typically at a higher cost.

Health Maintenance Organization (HMO) plans use a network of contracted local physicians and hospitals to provide member care. Generally, members must use these care providers to receive benefits for covered services, except in emergencies.

Point of Service (HMO-POS) plans include all the features of HMO plans plus the ability to go outside the contracted network for certain health care services - typically at a higher cost.

Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract. Enrollment in the plan depends on the plan's contract renewal with Medicare.

Erickson Freedom/Signat

for Erickson Advantage® Freedom/Signature Plans. Available in CO,KS,MD,MA,MI,NJ,NC,PA,TX,VA

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Medicare Advantage plans insured through UnitedHealthcare are offered to residents of Erickson Retirement Communities. These plans include benefits and services in addition to those covered under Original Medicare and do not require referrals for specialty care. Residents have several plans from which to choose. Most plans include an integrated Medicare Part D prescription drug benefit.

• Erickson Advantage Freedom (HMO-POS)
• Erickson Advantage Liberty (HMO-POS)
• Erickson Advantage Liberty no Rx (HMO-POS)
• Erickson Advantage Signature (HMO-POS)

Health Maintenance Organization (HMO) plans have a defined network of contracted local physicians and hospitals to provide member care. Generally, members must use these care providers to receive benefits for covered services, except in emergencies. 

Point of Service (HMO-POS) plans include all the features of HMO plans plus the ability to go outside the contracted network for certain health care services - typically at a higher cost.

Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract. Enrollment in the plan depends on the plan's contract renewal with Medicare.

AARP MedComp Referral - Copy

This is the referral-required version for AARP MedicareComplete Plans. Shows in AZ,FL,IL,LA,MA,RI,TX for AARP MedicareComplete

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Health Maintenance Organization (HMO) plans have a defined network of contracted local physicians and hospitals to provide member care. Generally, members must use these care providers to receive benefits for covered services, except in emergencies. Some HMO plans do not need referrals for specialty care.

Point of Service (HMO-POS) plans include all the features of HMO plans plus the ability to go outside the contracted network for certain health care services - typically at a higher cost. Some POS plans only cover out-of-network dental care. In addition, some POS plans do not require referrals for specialty care.

Preferred Provider Organization (PPO) plans offer members access to a network of contracted physicians and hospitals, but also allow them the flexibility to seek covered services from outside of the contracted network, usually at a higher cost. Members do not need a referral for specialty care.

PPO plans are available as either local PPO (certain counties within a state) or regional PPO (RPPO) offerings. RPPOs serve a larger geographic area - either a single state or a multi-state area. RPPOs offer the same premiums, benefits and cost-sharing requirements to all members in the region.

Document Library

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How to access your claim letters and documents

Document Library securely stores letters and other documents for up to 24 months.

To access, sign in to the UnitedHealthcare Provider Portal with your One Healthcare ID. In the portal menu, select Documents & Reporting > Document Library. If you don’t have a One Healthcare ID, register now.

When new documents are available in Document Library, a notification will be sent to the email address on file, which is typically the primary access administrator.

• If multiple staff members require notification, the primary access administrator can consider using a group email address
• We recommend checking Document Library regularly for new letters and actions needed

UHC MedicareDirect PFFS

UnitedHealthcare® MedicareDirect (PFFS) Plans. Shows in AZ, GA,KS,KY,MO,MT,NE,NH,OK,TX,VT,VA,WY.

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UHC MedicareDirect Medicare Advantage plans are Private Fee-For-Service (PFFS) plans that provide Medicare beneficiaries with a wide variety of health care benefits, often at a lower cost than Original Medicare. Members of UnitedHealthcare MedicareDirect plans are still covered under the Medicare program and have federally regulated rights and protections.

• UHC MedicareDirect (PFFS) – with drug coverage
• UHC MedicareDirect Patriot No Rx (PFFS) – no drug coverage

While the exact benefits will vary depending on the specific plan, UnitedHealthcare MedicareDirect plans provide members the option to seek care from any Medicare-eligible care provider without a referral, as long as the care provider agrees to the plan's terms, conditions and payment rates.

UHC Medicare Advantage - Header

This is the version for UHC Medicare Advantage Plans. Shows in AR,AZ,CA,CT,FL,GA,ID,IL,MN,MO,NH,NM,NV,NY,SC,TX,UT,VT,WI for UHC Medicare Advantage

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UHC Medicare Advantage plans cover features and benefits in addition to those included in Original Medicare. Members in some areas may have different plans from which to choose. The plans often include an integrated Medicare Part D prescription drug benefit.

Health Maintenance Organization (HMO) plans have a defined network of contracted local physicians and hospitals to provide member care. Generally, members must use these care providers to receive benefits for covered services, except in emergencies. Some HMO plans do not need referrals for specialty care.

Point of Service (HMO-POS) plans include all the features of HMO plans plus the ability to go outside the contracted network for certain health care services - typically at a higher cost. Some POS plans only cover out-of-network dental care. In addition, some POS plans do not require referrals for specialty care.

Preferred Provider Organization (PPO) plans offer members access to a network of contracted physicians and hospitals, but also allow them the flexibility to seek covered services from outside of the contracted network, usually at a higher cost. Members do not need a referral for specialty care.

PPO plans are available as either local PPO (certain counties within a state) or regional PPO (RPPO) offerings. RPPOs serve a larger geographic area - either a single state or a multi-state area. RPPOs offer the same premiums, benefits and cost-sharing requirements to all members in the region.

AARP MedicareComplete Copy

AARP MedicareComplete Copy for pages with his is the primary version for AARP MedicareComplete Plans. Shows in: AL,AR,CA,CO,CT,GA,HI,ID,IL,IN,IA,KS,KY,ME,MN,MO,NE,NV,NH,NJ,NM,NY,NC,OH,OK,OR,PA,SC,TN,UT,VT,VA,WA,WV,WI

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Health Maintenance Organization (HMO) plans have a defined network of contracted local physicians and hospitals to provide member care. Generally, members must use these care providers to receive benefits for covered services, except in emergencies. Some HMO plans do not need referrals for specialty care.

Point of Service (HMO-POS) plans include all the features of HMO plans plus the ability to go outside the contracted network for certain health care services - typically at a higher cost. Some POS plans only cover out-of-network dental care. In addition, some POS plans do not require referrals for specialty care.

Preferred Provider Organization (PPO) plans offer members access to a network of contracted physicians and hospitals, but also allow them the flexibility to seek covered services from outside of the contracted network, usually at a higher cost. Members do not need a referral for specialty care.

PPO plans are available as either local PPO (certain counties within a state) or regional PPO (RPPO) offerings. RPPOs serve a larger geographic area - either a single state or a multi-state area. RPPOs offer the same premiums, benefits and cost-sharing requirements to all members in the region.

AARP MedicareComplete Header

Header for pages that are tagged with "AARP Medicare Complete", this is the primary version for AARP MedicareComplete Plans. Shows in: AL,AR,CA,CO,CT,GA,HI,ID,IL,IN,IA,KS,KY,ME,MN,MO,NE,NV,NH,NJ,NM,NY,NC,OH,OK,OR,PA,SC,TN,UT,VT,VA,WA,WV,WI

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AARP Medicare Advantage from UHC plans cover features and benefits in addition to those included in Original Medicare. Members in some areas may have different plans from which to choose. The plans often include an integrated Medicare Part D prescription drug benefit.

Portal

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How to sign into the UnitedHealthcare Provider Portal

Sign in to the UnitedHealthcare Provider Portal with your One Healthcare ID.

• If you don’t have a One Healthcare ID, register now

UHC Dual Complete - Main

Tag with UHC Dual Complete for UnitedHealthcare Dual Complete® Plans showing in AL,AR,AZ,CO,CT,DC,DE,DC,FL,GA,HI,IA,IN,KS,KY,LA,MD,ME,MI,MS,MO,NE,NJ,NM,NY,NC,OH,OK,PA,RI,SC,TN,TX,VA,WA,WI,WV

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Health Maintenance Organization (HMO) plans use a network of contracted local physicians and hospitals to provide member care. Generally, members must use these care providers to receive benefits for covered services, except in emergencies. Some HMO plans do not require referrals for specialty care.

Point of Service (HMO-POS) plans include all the features of HMO plans plus the ability to go outside the contracted network for certain health care services - typically at a higher cost. Some POS plans only cover out-of-network dental care. In addition, some POS plans do not require referrals for specialty care.

Preferred Provider Organization (PPO) plans work with a network of contracted local physicians and hospitals, but also allows members the flexibility to seek covered services from outside of the contracted network, usually at a higher cost. Members do not need a referral for specialty care.

PPO plans are available as either local PPO (certain counties within a state) or regional PPO (RPPO) offerings. RPPOs serve a larger geographic area - either a single state or a multi-state area. RPPOs offer the same premiums, benefits and cost-sharing requirements to all members in the region.

UnitedHealthcare Medicare Advantage Special Needs Plans (SNPs) combine the hospital and doctor coverage of Medicare Parts A and B with Part D prescription drug coverage, plus additional features and benefits designed to meet the unique needs of identified Medicare consumer populations.

UHC Dual Complete - Header

Tag with UHC Dual Complete for UnitedHealthcare Dual Complete® Plans showing in AL,AR,AZ,CO,CT,DC,DE,DC,FL,GA,HI,IA,IN,KS,KY,LA,MD,ME,MI,MS,MO,NE,NJ,NM,NY,NC,OH,OK,PA,RI,SC,TN,TX,VA,WA,WI,WV

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UHC Dual Complete Special Needs Plans (SNP) offer benefits for people with both Medicare and Medicaid. These SNP plans provide benefits beyond Original Medicare, such as transportation to medical appointments and routine vision exams. Members must have Medicaid to enroll.

UHC Group - Header

Tag with UHC Group the UnitedHealthcare® Group Medicare Advantage Plans that display in AR,CA,CO,DE,DC,ID,IL,IN,KS,KY,LA,ME,MD,MA,MI,MN,MO,ND,NE,NH,NJ,NM,NY,NC,OH,OK,OR,PA,RI,SC,SD,TN,TX,UT,VT,VA,WA,WY,WI- they differ slightly from the smaller group with same name, but not in any particular way to explain in a title.

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UnitedHealthcare Group Medicare Advantage plans are only offered to groups such as employers, unions and government sub-entities. These plans provide group retiree Medicare beneficiaries with a variety of health care benefit plan choices, often with more benefits than those provided by Original Medicare. Plan members are still covered under the Medicare program and have federally regulated rights and protections.

Health Maintenance Organization (HMO) plans have a defined network of contracted local physicians and hospitals to provide member care. Generally, members must use these care providers to receive benefits for covered services, except in emergencies. Some HMO plans do not require referrals for specialty care.

Preferred Provider Organization (PPO) plans offer members access to a network of contracted local physicians and hospitals, but also allow them the flexibility to seek covered services from outside of the contracted network, and may have a higher cost. Members do not need a referral for specialty care.

We offer a national PPO (NPPO) plan to employers who qualify under a Centers for Medicare & Medicaid Services (CMS) Employer Group Waiver.

UHC Group Retiree - Header

Tag with UHC Group Retiree to show in the UnitedHealthcare® Group Medicare Advantage Plans that display in AL,AZ,FL,GA,HI,IA,WV - they differ slightly from the larger group, but not in any particular way to explain in a title.

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UHC Group Medicare Advantage plans are only offered to groups such as employers, unions and government sub-entities. These plans provide group retiree Medicare beneficiaries with a variety of health care benefit plan choices, often with more benefits than those provided by Original Medicare. Plan members are still covered under the Medicare program and have federally regulated rights and protections.

Health Maintenance Organization (HMO) plans have a defined network of contracted local physicians and hospitals to provide member care. Generally, members must use these care providers to receive benefits for covered services, except in emergencies. Some HMO plans do not require referrals for specialty care.

Preferred Provider Organization (PPO) plans offer members access to a network of contracted local physicians and hospitals, but also allow them the flexibility to seek covered services from outside of the contracted network, and may have a higher cost. Members do not need a referral for specialty care.

We offer a national PPO (NPPO) plan to employers who qualify under a Centers for Medicare & Medicaid Services (CMS) Employer Group Waiver.

UHC Nursing - Header

Tag with "UHC Nursing" to show with UnitedHealthcare® Nursing Home Plan in AL,AZ,CO,CT,DE,FL,GA,IL,IN,ME,MD,MA,MN,MO,NH,NJ,NY,NC,OH,OR,PA,RI,SC,TX,VA,WA,WI

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UHC Nursing Home Plans are Institutional Special Needs Plans (ISNPs) that provide individualized, closely monitored care to members who reside in contracted skilled nursing facilities. These plans help coordinate care through Optum nurse practitioners and physician assistants on behalf of UnitedHealthcare. UHC Nursing Home Plans do not require referrals for specialty care.

• UHC Nursing Home Plan (HMO I-SNP)
• UHC Nursing Home Plan (HMO-POS I-SNP)
• UHC Nursing Home Plan (PPO I-SNP)

Questions version 1

Chat with a live advocate 7 a.m.–7 p.m. CT from the UnitedHealthcare Provider Portal Contact Us page. You can also call Provider Services at 877-842-3210.

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Questions? We’re here to help.

Connect with us through chat 24/7 in the UnitedHealthcare Provider Portal.

UHC Complete Care C-SNP

body copy for the UHC Chronic Complete Care (C-SNP)" to show with UnitedHealthcare® Chronic Complete Care CSNP Plan in AL, AR, AZ, CA, CO, FL, GA, IA, ID, IL, MO, NM, NV, OR, SC, TX, TN, UT, WI

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The UHC Complete Care Chronic Special Needs Plan combines the hospital and doctor coverage of Medicare Parts A and B with Part D prescription drug coverage, plus additional benefits and services designed to meet the unique needs of identified Medicare consumer populations.

Chronic Condition SNPs are designed for consumers diagnosed with chronic conditions such as diabetes, chronic heart failure, and/or cardiovascular disorders. These plans offer benefits in addition to those covered under Original Medicare such as routine dental, vision, hearing, OTC credits, and routine podiatry services. Consumers must have a qualifying chronic condition to enroll.

Health Maintenance Organization (HMO) plans have a defined network of contracted local physicians and hospitals to provide member care. Generally, members must use these care providers to receive benefits for covered services, except in emergencies. Some HMO plans do not need referrals for specialty care.

Point of Service (HMO-POS) plans include all the features of HMO plans plus the ability to go outside the contracted network for certain health care services - typically at a higher cost. Some POS plans only cover out-of-network dental care. In addition, some POS plans do not require referrals for specialty care.

Preferred Provider Organization (PPO) plans offer members access to a network of contracted physicians and hospitals, but also allow them the flexibility to seek covered services from outside of the contracted network, usually at a higher cost. Members do not need a referral for specialty care.

PPO plans are available as either local PPO (certain counties within a state) or regional PPO (RPPO) offerings. RPPOs serve a larger geographic area - either a single state or a multi-state area. RPPOs offer the same premiums, benefits and cost-sharing requirements to all members in the region.

CS Pharmacy Resources - top

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Specialty medications can be covered under the pharmacy benefit, the medical benefit or both benefits, depending on the benefit structure for the member’s coverage.

Pharmacy benefit medications are typically self-administered by the patient or a caregiver, after filling the prescription through a pharmacy. These medications are labeled for self-administration by the Food and Drug Administration but may require some instruction to the patient or caregiver.

Typically, medications administered orally, topically or through subcutaneous injection by the patient or a caregiver after receiving instruction are covered under the pharmacy benefit.

Medical benefit medications are typically administered by a health care professional and monitored by a health care professional. The medication is administered in a physician office, at home, in an ambulatory infusion suite or in an outpatient facility. These medications can be administered by infusion, injection or intramuscularly with the help of an infusion nurse.

Specialty Pharmacy medications can be shipped from a specialty pharmacy directly to a health care setting (i.e., sourced) or a provider may purchase them directly using their standard distribution process (i.e., buy and bill). If the drugs are administered at home, they may be shipped from a specialty pharmacy directly to the member’s home.

Coverage of a requested medication depends on the member’s Medicaid coverage as determined by the State Medicaid agency, and the availability of a specific drug from a network specialty pharmacy may vary.

Medications obtained through a specialty pharmacy will be directly billed to the member’s health plan.

UnitedHealthcare Medicare Gold Silver SNP

UnitedHealthcare Medicare Silver/Gold Plans. Shows in AR,GA,MO,SC,TX,

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UnitedHealthcare® Special Needs Plans (SNP) plans combine the hospital and doctor coverage of Medicare Parts A and B with Part D prescription drug coverage, plus additional benefits and services designed to meet the unique needs of identified Medicare consumer populations.

Chronic Condition SNP plans are designed for consumers diagnosed with chronic conditions such as diabetes, chronic heart failure, and/or cardiovascular disorders. These plans offer benefits in addition to those covered under Original Medicare such as routine dental, vision, hearing, transportation, and routine podiatry services. Consumers must have a qualifying chronic condition to enroll.

• UnitedHealthcare Medicare Gold (Regional PPO C-SNP)
• UnitedHealthcare Medicare Silver (Regional PPO C-SNP)

Preferred Provider Organization (PPO) plans offer members access to a network of contracted physicians and hospitals, but also allow them the flexibility to seek covered services from outside of the contracted network, usually at a higher cost. Members do not need a referral for specialty care.

PPO plans are available as either local PPO (certain counties within a state) or regional PPO (RPPO) offerings. RPPOs serve a larger geographic area - either a single state or a multi-state area. RPPOs offer the same premiums, benefits and cost-sharing requirements to all members in the region.