Welcome to the Home for Care Provider Resources

For UnitedHealthcare Community Plan of New Jersey

Welcome

For UnitedHealthcare Community Plan of New Jersey

Welcome to the Home for Care Provider Resources

For UnitedHealthcare Community Plan of New Jersey

Welcome

For UnitedHealthcare Community Plan of New Jersey

UnitedHealthcare Community Plan of New Jersey 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

COVID-19 Resources for Providers

Provider Service Center

888-362-3368, available Monday – Friday from 6:00 a.m. – 6:00 p.m.

Claims Address

Medicaid and NJ Familycare

UnitedHealthcare Community Plan
P.O. Box 5250
Kingston, NY 12402-5250
Payer ID: 86047 

UnitedHealthcare Dual Complete ONE

UnitedHealthcare Dual Complete® ONE
P.O. Box 5250
Kingston, NY 12402-5250
Payer ID: 86047

Claims Appeal Address

Part C Appeals and Grievance Department
UnitedHealthcare Community Plan
Attn: Complaint and Appeals Department
P.O. Box 31364
Salt Lake City, UT 84131-0364

Part D Appeals and Grievance Department
Attn: CA124-0197
P.O. Box 6106
Cypress, CA 90630-9948

UM Appeals

Medicaid and NJ Familycare

UnitedHealthcare Community Plan
Attn: UM Appeals Coordinator
P.O. Box 31364
Salt Lake City, UT 84131

UnitedHealthcare Dual Special Needs (HMO SNP)

UnitedHealthcare Dual Complete One
Attn: UM Appeals Coordinator
P.O. Box 31364
Salt Lake City, UT 84131

All Providers

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

Credentialing and Recredentialing for Managed Long-Term Care Services and Supports (MLTSS) Providers

All documentation, inquires, and communication related to MLTSS credentialing and recredentialing information can be emailed to us at NJ_MLTSS_CRED@uhc.com.

  • If you are a participating MLTSS provider, you need to send us your recredentialing documents each year to ensure we have your most current complete required documentation.
  • All forms and documents can be emailed to NJ_MLTSS_CRED@uhc.com. Include the name of the facility and the words “Recredentialing Application” in the subject line.
  • Documents can also be mailed to:
    • UnitedHealthcare Community Plan
      Attn: MLTSS Credentialing
      283-289 Market Street 12th Floor, Suite 1202
      Newark, NJ 07102

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

Managed Long-Term Care Services and Supports (MLTSS) Providers

If you are interested in becoming a participating MLTSS provider, please email NJ_MLTSS_CRED@UHC.com for more information or to request a credentialing application. Include the name of the facility and the words “Credentialing Application” in the subject line.

Visit UHCCommunityPlan.com/NJ for current member plan information including sample member ID cards, provider directories, dental plans, vision plans and more.

Plan information is available for:

  • New Jersey FamilyCare
  • New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program

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

Care Provider Search

Search for a care provider by plan name:

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.  

If any provider or person discovers fraud and/or abuse occurring in any State or federally-funded health benefit program, they should report it to the Office of State Comptroller, New Jersey Medicaid Fraud Division hotline at 1-888-937-2835 or website at http://nj.gov/comptroller/divisions/medicaid.

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

Medicaid: Take 5 minutes to share your point of view

Last Modified | 07.09.2021

UnitedHealthcare Community Plan network providers will have the opportunity to share their feedback about their experience working with us by taking our Physician Satisfaction Survey. This survey applies to physicians who participate in Medicaid.

Learn More
New Jersey: New DME claim criteria

Last Modified | 06.30.2021

Effective Aug. 1, 2021, UnitedHealthcare Community Plan of New Jersey will deny DME claims that don't meet the DME Medicare Administrative Contractor (MAC) criteria.

Learn More
New Jersey: Breast pump coverage

Last Modified | 06.16.2021

UnitedHealthcare Community Plan of New Jersey will accept prior authorization requests for certain breast pumps starting April 5, 2021.

Learn More
Find COVID-19 vaccine availability for your state or territory

Last Modified | 05.21.2021

Use this list of local health departments to learn about availability in your area. Availability may vary by location and time. We encourage you to check back often as information becomes more available.

Learn More
New Jersey: Ambulance service claim requirements

Last Modified | 04.26.2021

Ambulance service claims for UnitedHealthcare Community Plan of New Jersey members must include origin and destination modifiers for reimbursement.

Learn More
View More News

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.