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 began managing UnitedHealthcare Medicare Advantage (MA) plans in the state of Alabama. Delegated services include Utilization Management.
- Notice: The delegation notice and orientation letter mailed and emailed to agencies is available here.
Agency Information Form:
The agency information form can be found online 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.
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 833-866-0393 or by emailing provider_network@myNEXUScare.com.
Please contact the myNEXUS Provider Network team with any questions at provider_network@myNEXUScare.com.