Complete verification form for C-SNP enrolled patients

When a Medicare beneficiary applies to enroll in a UnitedHealthcare Chronic Special Needs Plan (C-SNP), the Centers for Medicare & Medicaid Services (CMS) requires verification from a treating provider that the applicant has 1 or more of the plan’s 3 specific qualifying chronic conditions:

• Diabetes mellitus (pre-diabetes does not qualify)
• Cardiovascular disorders (cardiac arrhythmia, coronary artery disease, peripheral vascular disease and/or chronic venous thromboembolic disorder)
• Chronic heart failure

CMS rules do not allow a Medicare Advantage plan to use a diagnosis on a previously submitted claim, or any other previous proof of diagnosis, to support a C-SNP enrollment.

After the application is processed, UnitedHealthcare starts the verification process, and may begin verifying conditions before the member’s effective date with the plan. The plan has 60 days after the effective date to complete the verification of the qualifying chronic condition. Our verification team will reach out to the member’s provider (either a primary care provider [PCP] or specialist) to obtain the verification.

How to verify a patient’s qualifying condition

Providers need to complete the Chronic Condition Verification Form and submit to us in one of the following ways:

• Call the number on the form; a doctor or nurse can leave a message
• Email the completed form to mandrenrollment@uhc.com
• Fax the completed form to the number on the form

If a member’s qualifying condition is not verified within 60 days of enrollment, CMS requires that the member be disenrolled from the C-SNP. If you receive a request from UnitedHealthcare to verify a qualifying chronic condition for one of your UnitedHealthcare patients, please respond as soon as possible using one of the methods listed above.

About C-SNP plans

C-SNP plans offer tailored benefits and services to support qualifying conditions, including lower copays and prescription drug costs, care management and ancillary benefits, such as over the counter (OTC) and healthy food credits.