To enroll in a UnitedHealthcare Chronic Special Needs Plan (C-SNP), Medicare beneficiaries must meet specific health criteria. CMS mandates confirmation from a treating provider that the applicant is diagnosed with at least one of the plan’s three qualifying chronic conditions.

• Diabetes mellitus (pre-diabetic conditions are not considered eligible)
• Cardiovascular diseases, including heart rhythm abnormalities, coronary artery disease, circulation issues like peripheral vascular disease, and chronic venous thromboembolic conditions
• Chronic heart failure

CMS regulations prohibit using past diagnoses from claims or other prior records to validate eligibility for C-SNP enrollment.

Upon receiving the application, UnitedHealthcare launches the verification process, which may begin before the member’s plan start date. The plan has a 60-day period post-effective date to secure confirmation of the qualifying condition. Our dedicated verification team will reach out to the member’s healthcare provider, either a primary care doctor or a specialist, to obtain the necessary documentation.

How Providers Can Confirm a Qualifying Condition

Healthcare providers need to fill out a Chronic Condition Verification Form and send it back in one of these ways:

• Call the phone number on the form and leave a message (doctors or nurses can do this).
• Email the completed form to mandrenrollment@uhc.com.
• Fax the form to the number listed on it.

If the condition isn’t confirmed within those 60 days, CMS requires the member to be removed from the C-SNP. So, if UnitedHealthcare contacts you about verifying a patient’s condition, please respond as soon as you can using one of these methods.

About C-SNP Plans

C-SNP plans are built to support people with chronic conditions, offering things like lower out-of-pocket costs for doctor visits and medications, tailored care management, and extra benefits such as credits for over-the-counter (OTC) items and healthy groceries.