Frequently Asked Questions
For Care Providers and Practice Managers
UnitedHealthcare Dual Complete® ONE
A Fully Integrated Dual Special Needs
HMO Insurance Program for Medicare- and
Medicaid-eligible members in New Jersey
Frequently Asked Questions
 What is UnitedHealthcare Dual Complete® ONE?
 Who are Dual Complete ONE beneficiaries?
 Is Dual Complete ONE accepted state-wide in New Jersey?
 How do I know if I’m contracted to provide services for Dual Complete ONE members?
 If I already have a current contract with UnitedHealthcare Medicare Solutions and
UnitedHealthcare Community Plan, am I automatically contracted to provide services for
Dual Complete ONE?
 If a member has a Medicare card and a Medicaid card, do they have automatically have
D-SNP?
 Which member insurance ID card should our practice accept?
 What does a Dual Complete ONE member ID card look like?
 How can I check to see if a member is enrolled with Dual Complete ONE?
 How do I submit claims for Dual Complete ONE?
 What extra benefits do members receive with Dual Complete ONE?
 If I’m not a participating care provider for Dual Complete ONE, how can I become
contracted?
 Who can I contact if I have questions?
 What other references can I use to learn more about Dual Complete ONE?
Note: UnitedHealthcare Dual Complete® ONE and Dual Complete ONE may be used interchangeably in this presentation.
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What is UnitedHealthcare Dual Complete® ONE?
Dual Complete ONE (HMO SNP) is a single-payer, fully integrated Dual Eligible Special
Needs Plan (D-SNP) provided through UnitedHealthcare Community Plan for beneficiaries who
have Medicare* and Medicaid coverage. It’s a health insurance plan designed for individuals who
don’t have any cost sharing responsibility.
HMO SNP = Health Maintenance Organization Special Needs Plan.
Who are Dual Complete ONE beneficiaries?
Beneficiaries who have both Medicare* and Medicaid coverage are often referred to as
dual-eligible. To simplify the health coverage benefits of having both, fully integrated means
that Dual Complete ONE combines both Medicare* and Medicaid coverages into one insurance
plan.
Medicare
Medicaid
Federal Health Insurance Program
State Health Insurance Program
UnitedHealthcare Dual Complete® ONE
UnitedHealthcare Community Plan
Medicare & Medicaid fully integrated insurance plan
* To be eligible for UnitedHealthcare Dual Complete® ONE, beneficiaries must be entitled to Medicare Part A and enrolled in Medicare Part B.
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Service Area
Is UnitedHealthcare Dual Complete® ONE accepted
state-wide in New Jersey?
Sussex
In 2017, UnitedHealthcare Dual Complete® ONE
will service members in the following counties:
Passaic
Bergen
Morris
Warren
Atlantic
Bergen
Burlington
Camden *
Essex
Gloucester *
Hudson
Hunterdon *
Mercer
Middlesex *
Monmouth
Morris
Ocean
Passaic *
Somerset *
Union
Essex
Hudson
Union
Hunterdon
Newark
Somerset
New Brunswick
2016
counties
Middlesex
Long Branch
Mercer
Trenton
Monmouth
2017
expansion
counties
Toms River
Burlington
Ocean
Camden
* 2017 Dual Complete ONE expansion counties
Gloucester
Salem
Dual Complete ONE members
may visit in-network contracted care
providers state-wide.
Atlantic
Atlantic CIty
Cumberland
Cape May
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Contracting
How do I know if I’m contracted to provide services for Dual Complete® ONE
members?
If you’re unsure if you’re a contracted care provider for Dual Complete ONE, you can verify
your participation by calling Provider Services at 888-362-3368, Monday through Friday 6 a.m.
to 6 p.m. ET.
If I already have a current contract with UnitedHealthcare Medicare Solutions
and UnitedHealthcare Community Plan, am I automatically contracted to
provide services for Dual Complete ONE?
No. If a care provider has a current contract to participate with Medicare (UnitedHealthcare
Medicare Solutions) and Medicaid (UnitedHealthcare Community Plan NJFamilyCare), it
doesn’t automatically mean they’re contracted with Dual Complete ONE.
Some care provider contracts are set up differently. Please contact Provider Services at
888-362-3368 to verify if you’re currently contracted to provide services for members covered
under Dual Complete ONE.
Reimbursement for Dual Complete ONE is based on your UnitedHealthcare Community Plan
network agreement.
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Member ID Cards
If a member has a Medicare card and a Medicaid card, do they automatically
have D-SNP?
No, having Medicare and Medicaid coverage doesn’t necessarily mean that a member is
automatically enrolled in a D-SNP or has that coverage. However, the member may be eligible
to enroll in Dual Complete ONE because they’ve signed an enrollment form stating that they
agree to enroll in the plan.
A D-SNP member must enroll in a private health insurance plan that offers integrated coverage
for both Medicare and Medicaid, such as Dual Complete ONE. Beneficiaries can find more
information about enrolling in the plan at UHCCommunityplan.com > New Jersey > 2017
UnitedHealthcare Dual Complete® ONE (HMO SNP) > Steps to Sign Up.
Which member insurance ID card should our practice accept?
Dual Complete ONE members are issued a single ID card. When a member has a Dual
Complete ONE ID, it means they’re:
 Entitled to Medicare Part A and is enrolled in Medicare Part B
 Entitled to full Medicaid
 Enrolled in the Dual Complete ONE plan because they signed an enrollment form
 Familiar with the benefits of the Dual Complete ONE plan because they reviewed them with
a licensed UnitedHealthcare Community Plan representative
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Sample Member ID Card
What does a Dual Complete ONE member ID card look like?
As the care provider, you don’t need to ask a member with the above Dual Complete ONE ID
card for his/her Medicare and/or Medicaid ID card. The Dual Complete ONE
ID card already represents that they have both coverages.
Use the Dual Complete ONE UnitedHealthcare Medicare ID on the card as the
member ID # when submitting claims for reimbursement.
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Checking Member Enrollment
How can I check to see if a member is enrolled with Dual Complete ONE?
Log on to or register for an account at UnitedHealthcareOnline.com > Patient Eligibility &
Benefits to see if the patient is enrolled and to check their eligibility dates.
You can also call Provider Services at 888-362-3368, Monday through Friday, 6 a.m. to 6 p.m.
ET. Please have the following information ready:
• Your National Provider Identifier (NPI) or Tax ID #
• Name of care provider practice or facility
• Member ID # if you have it
• Member name
• Member date of birth
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Claim Submission
How do I submit claims for Dual Complete ONE?
UnitedHealthcare Community Plan has an automated system for seamless processing of claims for
members enrolled in both the UnitedHealthcare Community Plan Medicaid and Medicare under
Dual Complete ONE.
Using the member’s UnitedHealthcare Medicare ID from the Dual Complete ONE ID card, you’ll
only need to submit one claim. Your claims will automatically be processed first against the
Medicare benefits and then against the Medicaid benefits.
Expect to receive two provider remittance advices (PRAs), one for Medicare and one for Medicaid.
There’s no need to resubmit a secondary claim to UnitedHealthcare Community Plan.
Electronic Claims Submission
Mailed Claims Submission
Use Payer ID 86047
UnitedHealthcareOnline.com >
Claims & Payments > Claim
Submission (CMS-1500 claims only)
UnitedHealthcare Dual Complete® ONE
P.O. Box 5250
Kingston, NY 12402-5250
Dual Complete® ONE members should not
be balance billed for any covered benefit.
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Additional Benefits
What extra* benefits do members receive with Dual Complete ONE?

Health Products Debit Card with up to $564 in annual credits to buy health products at
participating retailers

Health Products Catalog with up to $700 in annual credits to order health products which
will be delivered directly to the member at no additional cost

$0 co-pay for personal emergency response system for extra support in emergencies

SilverSneakers® fitness program, which allows members to join a health club or fitness
center at no additional cost

24-hour NurseLineSM to speak with a nurse any time

No referrals needed for network specialists

$0 premium and cost-sharing, including Medicare Part D
co-pays

Medicare Part D “Extra Help” covers Part D premium

Medicaid covers all Medicare cost sharing on behalf of
members

Additional Medicaid benefits offered at $0 co-pay

Additional Medicaid-only drugs covered beyond
Medicare Part D
Large provider network

co-
* UnitedHealthcare Dual Complete ® ONE offers additional benefits beyond those offered through original Medicare.
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Contracting and Contacts
If I’m not a participating care provider for Dual Complete ONE, how can I
become contracted?
Call Provider Services at 888-362-3368 to find out if you’re a participating D-SNP care provider. If
you aren’t, let the representative know that you’re interested in obtaining a contract amendment to
include serving Dual Complete ONE D-SNP members. A Provider Network Advocate will contact
you to assist with your contract.
Who can I contact if I have questions?
If you have questions, please call Community Plan Provider
Services for Dual Complete ONE and
NJFamilyCare/Medicaid at 888- 362-3368, Monday through
Friday, 6 a.m. to 6 p.m. ET.
OR
Dual Complete ONE Member Services
800-514-4911, TTY: 711, 7 days a week, 8 a.m. to 8 p.m.
local time.
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Additional Resources
What other references can I use to learn more about Dual Complete ONE?
Click here 
to view and print a
copy of the
UnitedHealthcare
Dual Complete® ONE
Quick Reference
Guide (QRG)
 Click here
to view and print a
UnitedHealthcare
Dual Complete®
ONE
Benefit Structure.
 Click here to reference the UnitedHealthcare
Community Plan Provider Administrative Guide
for additional information on UnitedHealthcare
Dual Complete® ONE guidelines.
Click here 
to learn more about
UnitedHealthcare Dual Complete®
ONE member benefits.
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