![]() ![]() Important Update on Prescription Benefits: Ohio Medicaid Single Pharmacy Benefits Manager The pharmacist must also have an active consulting agreement with the member’s healthcare provider before services may be rendered. Search for a UnitedHealthcare network pharmacy below.ĭue to State Law and Medicaid requirements, members must have a referral from their healthcare provider (physician, nurse practitioner, or physician assistant) before a pharmacist may provide drug therapy management services. We will have a care coordinator work with you to make sure you get the care you need. If you can’t leave your home to get care, we can help. See pages 13-15 of the Handbook on getting prior approval (prior authorization) for services. The provider must first get approval from us to see you, or you may be billed. You may see an out-of-network provider if you need special care and we do not have a network provider with the right specialty. You also can call Member Services if you want a provider to be added to our network. If you want help finding a provider for any of our services, call Member Services at 1-83 (TTY: 711). The online provider directory gives the provider’s name, address, telephone numbers, professional credentials, specialty and board certification status. From there you can search behavioral health providers, specialists and facilities in your area. Click on the ‘Find a Provider’ ribbon on the top righthand side of the page. The provider directory is also online at /OhioRISE. You can also download a listof Child and Adolescent Needs and Strengths (CANS) providers. Just call Member Services at 1-83 (TTY: 711). You can request a printed copy of our provider directory. If you have questions? Visit /CommunityPlan or call Member Services at 1-80, TTY 711. We will also let you know when you can start seeing your new PCP. We will send you a new ID card with your new PCP listed. After your first month of membership, your PCP change will take effect the first day of the next month. If you change during your first month of membership, you PCP change will be effective immediately. They will also check to be sure the PCP you want to switch to is accepting new patients. Member Services will help make sure that the PCP you want to switch to is a participating provider with UnitedHealthcare Community Plan. Always work with your PCP first for any services you need. If you see a specialist without being sent by your PCP and without UnitedHealthcare Community Plan authorization in advance advance, you may have to pay the bill. There is no cost to you when we authorize the care or service in advance, before you see the non-network provider. We will work with your PCP to make sure you get the specialist or service when you need it, for as long as you need it, even if the provider is not currently a network provider. Sometimes members need to see a very specialized type of doctor. You don’t need to call us before seeing one of these providers. Network Providers have contracted with UnitedHealthcare Community Plan to care for our members. ![]() Physician Assistant (PA) - cares for children and adults.Nurse Practitioner (NP) - cares for children and adults.Internal medicine doctor (also called an internist) - cares for adults.Family doctor (also called a general practitioner) - cares for children and adults. ![]() You can choose between many types of network providers for your PCP. Routine care, including yearly checkups.Each family member can have their own PCP, or you may all choose to see the same person. When you see the same PCP over time, it’s easier to develop a relationship with them. The main doctor you see is called a Primary Care Provider, or PCP. ![]()
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