Web Update  Unison Health Plan of Pennsylvania is now UnitedHealthcare Community Plan. It's the same health plan, but it has a new name. Information about our Pennsylvania plan will be moving to UHCCommunityPlan.com soon.

Forms

• Abortion Certification - Physician
• Abortion Statement - Member
• Ancillary Provider Credentialing Application
• Case Management Referral Form
• Coordination of Care Form
• Direct Member Reimbursement
• Electronic Funds Transfer Authorization Form
• Hysterectomy
• Hysterectomy (Spanish)
• Inpatient Review Information Form
• IV Re-Authorization Request Form
• Maternity Outcome Authorization Form 
• Member Education Request Form 
• NICU Discharge Assessment for Hospitals
• Obstetrical Needs Assessment Form 
• Practitioner Credentialing Application
• Prior Authorization Fact Sheet
• Provider Supply Order Form
• Sterilization
• Sterilization (Spanish)
• UBH Provider Forms - For DE, DC & PA ONLY 

EDI

Emdeon Batch Transactions:

• 834 Benefit Enrollment and Maintainence
• 835 Health Care Claim Payment/Advice
• 837 Health Care Claim: Professional
• 837 Health Care Claim: Institutional
• 837 Health Care Claim: Dental
   

Real Time Transactions:

• 270/271 Health Care Eligibility Benefit Inquiry and Response
• 276/277 Health Care Claim Status Request and Response
• 278 Health Care Services Review -- Request for Review and Response