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

• Ancillary Provider Credentialing Application
• Benefit Limit Exception Process Form
• 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 
• Medical Assessment Form PA 635
• Member Education Request Form
• NICU Discharge Assessment for Hospitals
• Obstetrical Needs Assessment Form 
• Physician Certification Abortion Form
• Practitioner Credentialing Application
• Prior Authorization Program Exception Form
• Prior Authorization Fact Sheet
• Provider Supply Order Form
• Recipient Certification Abortion 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