January 1, 2021 at 12:00 AM CT


Starting Jan. 1, 2021, all presumptive eligibility Medicaid members in Kentucky will be enrolled in managed care and assigned to UnitedHealthcare Community Plan. This means some of your patients will be switched to UnitedHealthcare Community Plan on Jan. 1st, 2021. Starting on that date, please submit claims for these members to us.

If you have questions, please reach out to our provider call center (866) 633-4449, Monday-Friday 8 a.m.-6 p.m. ET including on Jan. 1st.

Welcome to the Home for Care Provider Resources

For UnitedHealthcare Community Plan of Kentucky

Welcome

For UnitedHealthcare Community Plan of Kentucky

UnitedHealthcare Community Plan of Kentucky Homepage

We know you don't have time to spare, so we put all the UnitedHealthcare Community Plan resources you need in one place. Use the navigation on the left to quickly find what you're looking for. Be sure to check back frequently for updates.

Prior Authorization and Notification Resources

Current Policies and Clinical Guidelines

Provider Administrative Manual and Guides

Provider Services Call Center: 

Phone:  866-633-4449 available 8 a.m. – 6 p.m. Eastern Time (including Federal holidays)

Provider Relations:

Email:  kentucky_pr_team@uhc.com

Network Management Resource Team

Phone:  877-842-3210

Email:  networkhelp@uhc.com

Mailing Address:

UnitedHealthcare Community Plan of Kentucky

9100 Shelbyville Rd., Suite 270

Louisville, KY  40222

Technical Support:

Phone:  866-209-9320

Behavioral Health Services

Phone:  800-888-2998

Online:  Providerexpress.com

Pharmacy Services:

Phone:  844-569-4147 (OptumRx)

Online:  Professionals.optumrx.com

Prior Auth Phone:  800-310-6826

UnitedHealthcare Dental:

Phone 877-897-4941

Online: uhcdental.com

MARCH Vision Care:

Phone:  844-516-2724

Online Reference Guides:  marchvisioncare.com

Contact Information:  providers.eyesynergy.com

General Inquiries: 

may be sent to ky_provider_requests@uhc.com

Disclaimer:  This email inbox is intended to be used solely for communications that do not contain unencrypted Protected Health Information (PHI). Email messages and any documents containing PHI are protected by various state and federal laws including 45 C.F.R. Part  164. No emails or documentation should be sent to this inbox that contain PHI unless the communication is encrypted. Examples of PHI include a member’s name, date of birth, any detail regarding their medical condition including diagnoses and any other combination of identifiable information.

For Credentialing and Attestation updates, contact the National Credentialing Center at 1-877-842-3210.

Behavioral Health Providers

Learn how to join the Behavioral Health Network, review Community Plan Behavioral Health information, or submit demographic changes at Community Plan Behavioral Health.

Facility/Hospital-Based Providers, Group/Practice Providers and Individually-Contracted Clinicians

The state-specific requirements and process on how to join the UnitedHealthcare Community Plan network is found in the UnitedHealthcare Community Plan Care Provider Manuals.  

Learn about requirements for joining our network

If you have questions about KHIE or want to begin the connection process, please email us at KHIE@ky.gov, call us at 502-564-7992 EXT 2800 or find us online https://khie.ky.gov/Pages/index.aspx.

Overview

The Centers for Medicare & Medicaid Services (CMS) established the Medicaid Managed Care Rule to:

  • Promote quality of care
  • Strengthen efforts to reform the delivery of care to individuals covered under Medicaid and Children’s Health Insurance Plans (CHIP)
  • Strengthen program integrity by improving accountability and transparency

Enhance policies related to program integrity With the Medicaid Managed Care Rule, CMS updated the type of information managed care organizations are required to include in their care provider directories.

Visit UHCCommunityPlan.com/KY for current member plan information including sample member ID cards, provider directories, value-added benefits, dental plans, vision plans and more. 

Plan information is available for:

  •  UnitedHealthcare Community Plan of Kentucky

Member dental plan and benefit information can be found at UHCCommunityPlan.com/KY and myuhc.com/communityplan.
Access a PDF Provider Directory by Region:

The best way for primary care providers (PCPs) to view and export the full member roster is using the CommunityCare tool, which allows you to:  

  • Identify Medicaid recipients who need to have their Medicaid recertification completed and approved by the State Agency in order to remain eligible to receive Medicaid benefits
  • See a complete list of all members, or just members added in the last 30 days
  • Export the roster to Excel
  • View most Medicaid and Medicare SNP members’ plans of care and health assessments
  • Enter plan notes and view notes history (for some plans)
  • Obtain HEDIS information for your member population
  • Access information about members admitted to or discharged from an inpatient facility
  • Access information about members seen in an Emergency Department

For help using CommunityCare, please see our Quick Reference Guide. If you’re not familiar with our portal, go to UHCprovider.com/portal.

Reporting Fraud, Waste or Abuse to Us

When you report a situation that could be considered fraud, you’re doing your part to help save money for the health care system and prevent personal loss for others. If you suspect another provider or member has committed fraud, waste or abuse, you have a responsibility and a right to report it. 

Taking action and making a report is an important first step. After your report is made, we will work to detect, correct and prevent fraud, waste, and abuse in the health care system.

Call us at 1-844-359-7736 or visit uhc.com/fraud to report any issues or concerns.  

UnitedHealthcare Dual Complete® Special Needs Plan

UnitedHealthcare Dual Complete Special Needs Plans (SNP) offer benefits for people with both Medicare and Medicaid. These SNP plans provide benefits beyond Original Medicare, and may include transportation to medical appointments and vision exams. Members must have Medicaid to enroll.

Current News, Bulletins and Alerts

Health Insurance Portability and Accountability Act (HIPAA) Information

HIPAA standardized both medical and non-medical codes across the health care industry and under this federal regulation, local medical service codes must now be replaced with the appropriate Healthcare Common Procedure Coding System (HCPCS) and CPT-4 codes. View our updated HIPAA information for UnitedHealthcare Community Plan.

Integrity of Claims, Reports, and Representations to the Government

UnitedHealth Group requires compliance with the requirements of federal and state laws that prohibit the submission of false claims in connection with federal health care programs, including Medicare and Medicaid. View our policy.

Disclaimer

If UHG policies conflict with provisions of a state contract or with state or federal law, the contractual / statutory / regulatory provisions shall prevail. To see updated policy changes, select the Bulletin section at left.