1. UnitedHealthcare Dual Complete® ONE
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

2. 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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3. 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
Federal Health Insurance Program
Medicaid
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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4. Service Area
Trenton
Newark
New Brunswick
Toms River
Long Branch
Atlantic CIty
Burlington
Camden
Cape May
Cumberland
Gloucester
Hunterdon
Morris
Salem
Somerset
Sussex
Warren
Atlantic
Bergen
Essex
Hudson
Mercer
Middlesex
Monmouth
Ocean
Passaic
Union
Is UnitedHealthcare Dual Complete® ONE accepted state-wide in New Jersey?
In 2017, UnitedHealthcare Dual Complete® ONE will service members in the following counties: 
Atlantic
Bergen
Burlington
Camden *
Essex
Gloucester *
Hudson
Hunterdon *
Mercer
Middlesex *
Monmouth
Morris
Ocean
Passaic *
Somerset *
Union
2016 counties
2017 expansion
counties
* 2017 Dual Complete ONE expansion counties
Dual Complete ONE members
may visit in-network contracted care
providers state-wide.
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5. 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 , 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 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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6. Member ID Cards
If a member has a Medicare card and a Medicaid card, do they have 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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7. 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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8. 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 , 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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9. be balance billed for any covered benefit.
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.
Dual Complete® ONE members should not
be balance billed for any covered benefit.
Electronic Claims Submission
Use Payer ID
UnitedHealthcareOnline.com > Claims & Payments > Claim Submission (CMS-1500 claims only)
Mailed Claims Submission
UnitedHealthcare Dual Complete® ONE P.O. Box 5250 Kingston, NY
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10. 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
* UnitedHealthcare Dual Complete ® ONE offers additional benefits beyond those offered through original Medicare.
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11. Contracting and Contacts
If I’m not a participating care provider for Dual Complete ONE, how can I become contracted?
Call Provider Services at 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 , Monday through Friday, 6 a.m. to 6 p.m. ET. OR
Dual Complete ONE Member Services
, TTY: 711, 7 days a week, 8 a.m. to 8 p.m. local time.
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12. 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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