Welcome to the Home for Care Provider Resources

For UnitedHealthcare Community Plan of Maryland

Welcome

For UnitedHealthcare Community Plan of Maryland

UnitedHealthcare Community Plan of Maryland 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 menu 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

Hours of Operation: 8:00 am - 6:00 pm EST
Provider Call Center: 877-842-3210
Member Services Number: 800-318-8821 (TTY 711),  Monday-Friday, 8:00 am to 7:00 pm EST

Mailing Address:
UnitedHealthcare Community Plan
10175 Little Patuxent Parkway
Columbia, MD 21044

Claims Mailing Address:
UnitedHealthcare Community Plan
PO Box 31365
Salt Lake City, UT 84131 

Utilization Denial & Appeals Department Mailing Address:
UM Denial & Appeals Department
PO Box 31365
Salt Lake City, UT 84131

Claims Appeals Mailing Address:
UnitedHealthcare Community Plan Appeals-Maryland
PO Box 31365
Salt Lake City, UT 84131

Credentialing Updates: 
Contact the National Credentialing Center at 1-877-842-3210.

Additional Resources

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.

Visit UHCCommunityPlan.com/MD for current member plan information including provider directories, dental plans, vision plans and more.

View a sample member ID card here: Member ID card

Plan information is available for:

  • Maryland HealthChoice

Member plan and benefit information can also be found at UHCCommunityPlan.com/MD and myuhc.com

Referrals are required for most specialty services.

The links below provide more information on our referral requirements including how to submit online referrals.

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.

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

Coordination of Care Resources - UnitedHealthcare Community Plan of Maryland

Last Modified | 10.30.2020

You can access state and UnitedHealthcare tools to stay updated on the care your patients who are our members receive from other health care providers.

Learn More
Medical Policy Documentation Requirement Updates Frequently Asked Questions - UnitedHealthcare Community Plans

Last Modified | 10.20.2020

We’ve refined medical policy documentation requirements and enhanced clinical coverage criteria for various procedures. This document contains information on effective dates by state and frequently asked questions.

Learn More
Practice Matters Summer 2020 - Maryland

Last Modified | 10.14.2020

Important information for health care professionals and facilities.

Learn More
View More News
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UHC On Air gives you in-depth program information and meaningful updates from UnitedHealthcare 24/7and from any device.

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HEDIS Medical Record Collection

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.