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As of January 1st, 2018 UnitedHealthcare Community Plan will no longer provide Medicaid and Long Term Care coverage in Delaware. For questions about 2018 services, members can call their new Health Plan Member Service’s phone number, it is on their ID card. If members have questions related to any services prior to January 1, 2018, members can call United Healthcare Community Plan member services at 1-877-877-8159.
This change doesn’t affect UnitedHealthcare Medicare, including Institutional Special Needs Plan (I-SNP) and Dual Complete Plan (DSNP) or UnitedHealthcare Commercial Plan members.
Healthcare Providers can continue to call Provider Services at 1-800-600-9007. For questions regarding behavioral health, please call 1-877-614-0484. For questions regarding Dental, please call 1-855-609-5152.
- Impormasyon ti Mangipapaay
- Behavioral Health Resources
- Dagiti Pagwarnakan
- Rekonsiderasyon ti Tuntonen ken Apela
- Impormasyon ti Claims ken Miyembro
- Espesialisasion maipanggep iti puso
- Klinikal a Pagannurotan ti Trabaho
- Cultural Competency Library
- Dual Complete (HMO SNP) Program
- Electronic Data Interchange (EDI)
- Medicare Part D Materyales ti Panangadal
- Dagiti Warnakan
- Programa ti Parmasiya
- Pagalagaden ti Pinagisubli
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.
Medicaid Managed Care Rule External FAQs (PDF 64.57 KB)
Medicaid Managed Care Rule Presentation (PDF 90.71 KB)
Click on the arrow above to view manuals and forms.
Provider Administrative Manuals
- Delaware Medicaid and DSHP Plus Long Term Care Provider Manual (PDF 1.63 MB)
- Quick Reference Guide for the UnitedHealthcare Administrative Guides (PDF 112.23 KB)
Sangkagrupoan a Panagiwaragawag ti Panagtagikua ken Panagtenggel iti Interes a Porma pinduten ditoy (PDF 519.75 KB) para iti PDF a bersyon.
Indibidual a Panagiwaragawag ti Panagtagikua ken Panagtenggel iti Interes a Porma pinduten ditoy (PDF 427.75 KB) para iti PDF a bersyon.
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 the following network specialty pharmacy:
Ispesyalista a Parmasiya ti Network
Numero iti Telepono
The following specialty pharmacies also provide certain types of specialty medications:
Ispesyalista a Parmasiya ti Network
Kategorya ti Panagagas
Numero iti Telepono
Accredo (nursing services)
Option Care (nursing services)
Ispesyalista a Parmasiya ti CVS Caremark
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.
Click on the arrow above to view additional links and information.
- Cultural Competency https://www.thinkculturalhealth.hhs.gov/
- Medicaid Assistance Office http://www.dhss.delaware.gov/dhss/dmma/contact.html
- Advance Directives and Living Wills http://www.dhss.delaware.gov/dhss/dsaapd/advance.html
- Delaware Helpline (800) 464-HELP http://www.delaware211.org/
- Delaware Healthy Children Program http://www.dhss.delaware.gov/dss/dhcp.html
- United Behavioral Health (OptumHealth Behavioral Solutions) www.providerexpress.com
- NCQA http://www.ncqa.org/tabid/100/Default.aspx
Wellness Registry for Delaware Community Plan Providers
The Wellness Registry is a community services database that contains resources throughout the State of Delaware that can assist in meeting our member’s needs. It will help you connect members to wellness programs, such as health education and disease management classes. UniteHealthcare uses the Healthify database as the wellness registry.
To access the Wellness Registry:
- Click on the Link button at the top right of UHCprovider.com and sign in with your Optum ID
- From the Link Dashboard, navigate to the Menu at the top left and choose myData Connection Dashboard
- Then, from the myData Connection dashboard, click on the Community Resource Finder tile to access the Healthify Wellness Registry
UnitedHealthcare 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.
Click on the arrow above to view the prior authorization archive.
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. Dagitoy a pagalagadan ken pagannurotan ket maipaay para ti panangipakaammo a ranta, ken saan a mangbukel ti medikal a balakad.
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.
Integridad ti Claims, Reports, ken Panangibagi iti Gobyerno
UnitedHealth Grupo ket dawatenna ti panagtungpal kadagiti dawdawaten ti pederal ken paglintegan ti estado nga mangiparit ti panagsumite ti palso a claims a maikamang iti pederal a programa ti pannakasalwad ti salun-at, pakairamanan ti Medicare ken Medicaid.
View our policy (PDF 38.15 KB).
If UHG policies conflict with provisions of a state contract or with state or federal law, the contractual / statutory / regulatory provisions shall prevail. Tapno makita ti pakaaamo a panagbalbaliw ti pagalagadan, pilien ti Pagwarnakan a seksiyon iti kanigid.