myNEXUS | UnitedHealthcare, Inc. Resources
myNEXUS is proud to announce its partnership with UnitedHealthcare, Inc. to provide utilization management for home health services in Alabama. Please find important announcements, documents, and forms listed below.
- Delegation: Effective July 1st, 2021, myNEXUS will manage UnitedHealthcare Medicare Advantage (MA) plans in the state of Alabama. Delegated services will include Utilization Management.
- Orientation Sessions: myNEXUS is offering training sessions to orient home health agencies with myNEXUS services. Registration for orientation sessions is listed at the bottom of this page. Please select the date and time of your choice below to register for a session.
- Notice: The delegation notice and orientation letter mailed and emailed to agencies is available here.
Authorization Program Materials:
In-Scope Plan List: The list of in-scope UnitedHealthcare plans for the myNEXUS delegation.
myNEXUS Provider Portal: myNEXUS encourages providers to utilize the online Provider Portal to submit authorization requests.
Fax Number Confirmation Form: Online Form providers use to confirm their fax numbers for authorization requests.
Agency Information Form: Online form providers use to submit their information if not populating in portal.
myNEXUS utilizes CMS National and Local Coverage Determinations (NCD and LCDs) when applicable, or UHC medical policies and clinical Utilization Management guidelines to facilitate the appropriate evaluation of medical necessity by including assessment of the member throughout the continuum of care. A synopsis of the criteria is available to Providers and Members on request and free of charge by calling myNEXUS at 866-936-1635 or by emailing provider_network@myNEXUScare.com.
Please contact the myNEXUS Provider Network team with any questions at provider_network@myNEXUScare.com.