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UnitedHealthcare® Shared Services
Provider Resources

Access to UnitedHealthcare® Options PPO Network for Independent Health members. In December 2023, certain Independent Health products will include access to the UnitedHealthcare Options PPO network for primary and travel coverage. Access and eligibility depend on the product and member’s effective date.

PROVIDER RESOURCES
IDENTIFY AN ELIGIBLE MEMBER
PRIOR AUTHORIZATION
COMMERCIAL FORMS
SELF-FUNDED FORMS
WHO TO CONTACT
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How to Identify an Eligible Independent Health Member

Verify the member’s coverage and ability to use the UnitedHealthcare Options PPO network by checking the member’s Independent Health ID card. If the UnitedHealthcare Options PPO logo appears on the front or back of the card, member is eligible for benefits when accessing care outside of the Independent Health service area.

UnitedHealthcare Options PPO used as Primary Network

PPO/Primary Network:

  • Independent Health logo on the front
  • UnitedHealthcare Options PPO logo on the front

UnitedHealthcare Options PPO logo on the front

Card image
card back

 

UnitedHealthcare Options PPO used as Out-of-Area/Travel Network

PPO/Travel Benefit:

  • Independent Health logo on the front
  • UnitedHealthcare Options PPO logo on the back

UnitedHealthcare Options PPO logo on the back

card front
card back

UnitedHealthcare Options PPO used as Primary Network

  • Independent Health Self-Funded logo on the front
  • UnitedHealthcare Options PPO logo on the front

UnitedHealthcare Options PPO logo on the front

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test

UnitedHealthcare Options PPO used as Out-of-Area/Travel Network

  • Independent Health Self-Funded logo on the front
  • UnitedHealthcare Options PPO logo on the back

UnitedHealthcare Options PPO logo on the back

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Prior Authorization

Prior authorization may be required for some services and medications. Please refer to this prior authorization policy or code list to determine whether the service/treatment or drug needs prior authorization.

If the service requires prior authorization, please choose the appropriate Commercial or Self-Funded form from the lists below. Note: Self-Funded members are identified with the ‘Independent Health Self-Funded Services’ logo on the front on their ID card.

Commercial Fully Insured Forms

Appeal Complaint Form

UnitedHealthcare Provider use only. Use to lodge a written appeal of an adverse determination on behalf of a Commercial Member.

Genetic Testing Authorization Request Form

UnitedHealthcare Provider use only. Complete this form to request genetic testing authorization for Commercial Members.

Home Health Care Request Form

UnitedHealthcare Provider use only. Complete this form to request home health care for Commercial Members.

Non-Emergent Transportation Request

UnitedHealthcare Provider use only. Complete this form to request non-emergent transportation for Commercial Members

Out of Area Transfer Request Form

UnitedHealthcare Provider use only. Complete this form to request to transfer to an out of area facility for Commercial Members.

Pharmacy Drug Authorization Form

UnitedHealthcare Provider use only. Complete this form to request pharmacy drug authorization for Commercial Members.

Prior Authorization Request Form Commercial

UnitedHealthcare Provider use only. Complete this form to request prior authorization for Commercial Members.

Skilled Nursing Prior Authorization Form

UnitedHealthcare Provider use only. Complete this form to request skilled nursing prior authorization for Commercial Members.

Self-Funded Insured Forms

Appeal Complaint Form

UnitedHealthcare Provider use only. Used to submit a written appeal of an adverse determination on behalf of a Self-Funded Member.  Please note this form must include the member's signature.

Pharmacy Drug Authorization Form

UnitedHealthcare Provider use only. Complete this form to request pharmacy drug authorization for Self-Funded Members.

Prior Authorization Request Form Self-Funded

UnitedHealthcare Provider use only. Complete this form to request prior authorization for all applicable services for Self-Funded Members.

Drug Formularies

Independent Health Drug Formularies are lists of drugs that are covered under the member’s plan. Some drugs may appear on different tiers depending on the formulary.

These formulary drugs are recommended by the Independent Health Pharmacy & Therapeutics Committee. These drugs are selected based on a quality evaluation of safety, effectiveness, unique qualities, and costs.

View Formularies

UnitedHealthcare Provider Services

For questions related to member eligibility, claims submissions and status, authorization status and appeal status, please contact UnitedHealthcare Provider Services.

(866) 322-3807

About Independent Health

Established in 1980, Independent Health is an independent, not-for-profit health plan headquartered in Buffalo, New York. In all, Independent Health and its affiliates serve a total of more than 550,000 lives across the country. Learn more about us here.

© Independent Health Association, Inc.

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