Welcome to the Home for Care Provider Resources

For UnitedHealthcare Community Plan of Tennessee

Welcome

For UnitedHealthcare Community Plan of Tennessee

Welcome to the Home for Care Provider Resources

For UnitedHealthcare Community Plan of Tennessee

Welcome

For UnitedHealthcare Community Plan of Tennessee

UnitedHealthcare Community Plan of Tennessee Homepage

COVID-19 vaccine information and FAQs

Get the latest COVID-19 vaccine information and FAQs from the TN Department of Health.

Interested in becoming a COVID-19 vaccinating provider? Learn more on their website.

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

Behavioral Health

COVID-19 Resources for Providers

 

Through an online portal, axialPRACTICE gives you access to resources that help monitor a member’s overall opioid-related risks, including the member’s medication and treatment history from other care providers, information to help you treat common pain complaints, support for managing complex cases, and the opportunity to consult directly with licensed axialHealthcare pharmacists when developing care plans for members. 

Login to the axialPRACTICE Provider Validation Tool using your Optum ID. You will need to fill out a short form with your Tax ID Number (TIN) and National Provider Identifier (NPI) number.

Together, We Can Work to Address Tennessee’s Opioid Crisis

If you’d like to provide evidence-based care for your patients diagnosed with Opioid Use Disorder (OUD), or to identify those at risk, we’re pleased to announce that we’re offering a new Project ECHO training series on Buprenorphine-focused Medication Assisted Treatment (BMAT), starting July 31, 2019.

The series is a collaboration between East Tennessee State University, UnitedHealthcare Community Plan, Amerigroup and BlueCross BlueShield of Tennessee. BMAT Project ECHO aims to equip care providers with the latest clinical information and best practices so you can help improve access for patients suffering from OUD. The six-week online training consists of brief educational sessions, followed by case presentations. Training will be available through July 2020. You can join at any time, even if you missed the first session(s).

BMAT Project ECHO is an interactive experience offering free:

  • Training and support on how to best deliver BMAT services.
  • Weekly didactic sessions with addiction/OUD subject matter experts.
  • Continuing education credits, including Continuing Medical Education (CME).*

After participating in the BMAT Project ECHO series, you should be able to:

  • Identify key components of the MAT model.
  • Explain the benefits of providing MAT.
  • Know how to use the interdisciplinary approach that best fits your practice.

To participate in an upcoming clinical tele-education session, all you need is a computer with a camera and microphone to connect using Zoom, the free, online video conferencing platform. You don’t need a Zoom account to participate.

To learn more and register for an upcoming training, visit etsu.edu/etsubmatecho

*BMAT Project ECHO will offer CME credit to participants in accordance with national CME standards utilized by East Tennessee State University CME office, including prior review of materials for presentation and evaluation, and appropriate disclosure to participants with regard to potential conflicts of interest of presenters.

Good health outcomes start in the communities where your patients live. Starting October 2, we invite you to Connect with Us by taking the Providers CARE Survey.

By taking the survey, you’ll give us information about challenges your patients are facing in their communities. Our goal is to help you improve your patients’ health by:

C= Connecting them with community resources (like food pantries and housing help);

A= Acting for better health by teaching them about their care needs;

R=Reducing stigma by showing compassion to others and taking time to think about your actions and thoughts about yourself and others; and

E= Encouragement. Take the time to listen to your patients. Treating them with kindness and support can help them take the steps they need for better health and support them on their journey to their best life.

We are here to help you Connect your patients to CARE. The CARE survey will ask you about the social conditions impacting your patients and learning opportunities that can assist your practice team.

To fill out the survey, please visit https://www.tn.gov/tenncare/providers/social-and-health-needs.html

Your answers will not have your name on them and will be combined with information from other providers.

Thank you for caring about the health of your community.

We’re publishing this notification at TennCare’s request.

Provider Call Center

800-690-1606, available Monday-Friday from 8 a.m. – 6 p.m. Eastern Time.

Mailing Addresses 

Postal Mailing Address
UnitedHealthcare Community Plan
8 Cadillac Drive, Suite 100
Brentwood, TN 37027

Claims Address
UnitedHealthcare Community Plan
P.O. Box 5220
Kingston, NY 12402

Utilization Management Appeals Address
UnitedHealthcare Community Plan
P.O. Box 5220
Kingston, NY 12402

Part C Claims 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

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

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.

View TennCare's policy related to fraud and the Federal and State False Claims Act.

To report fraud, waste, or abuse concerns you can call 800-690-1606 (UnitedHealthcare Community Plan tipline) or 800-433-3982 (Division of TennCare & Office of Inspector General). Or, you can report fraud, waste and abuse concerns at the following link: EthicsPoint - UnitedHealthcare Fraud, Waste and Abuse Hotline.

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

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/TN for current member plan information including sample member ID cards, provider directories, dental plans, vision plans and more.

Plan information is available for:

  • UnitedHealthcare Community Plan - TennCare

Member plan and benefit information can also be found atUHCCommunityPlan.com/TN and myuhc.com/communityplan.

Member Rights and Responsibilities

The UnitedHealthcare Community Plan Member Rights and Responsibilities can be found in the Provider Manual. Member Rights and Responsibilities are distributed to new members upon enrollment. On an annual basis, members are referred to their handbook to review their Member Rights and Responsibilities.

Need to make a change to your provider or facility directory information? 

TennCare

UnitedHealthcare Community Plan members can access and manage their TennCare benefit information online with TennCare Connect.

CoverKids

Effective Jan. 1, 2021 UnitedHealthcare Community Plan is participating in the CoverKids program.  

 

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.  

Project ECHO: East Tennessee State University
Buprenorphine Medication Assisted Treatment (BMAT) Project ECHO Trainings Coming Soon
Learn more or register for an upcoming training

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

  • Tennessee: Inappropriate Primary/Principle Diagnosis Policy, Facility Update

    Last Modified | 04.30.2021

    It was previously communicated Oct. 1, 2020, on the Community Plan Portal, that the UnitedHealthcare Community Plan is implementing a new Inappropriate Primary Diagnosis Policy, Facility, for facility claims. Implementation of this new facility policy has been delayed until on or after date of process June 1, 2021.

    Learn More
  • Last Modified | 04.15.2021

    UHCprovider.com and the UnitedHealthcare Community Plan care provider administrative manuals contain helpful information that give you and your staff an easy way to find important topics, such as prior authorization requirements, eligibility verification, claim submission, updated protocols and the TennCare Regulatory Appendix Addendum, as well as other resources and UnitedHealthcare contact information.

    Learn More
  • Last Modified | 04.15.2021

    The annual 2020 EPSDT medical record review was conducted for each of the 3 Tennessee grand regions. A total of 45 providers were included in the review, with a total of 135 individual charts reviewed. The average score of all 3 regions combined was 94%. The elements most frequently not documented and identified as opportunities for improvement were Vaccines and Physical Exams. Please refer to the 2020 American Academy of Pediatrics (AAP) and Bright Futures Recommendations for Preventive Pediatric Health Care for current guidelines.

    Learn More
  • Last Modified | 04.15.2021

    If you object to this Appendix or no longer wish to participate in our network, you can send us written notice on official letterhead.

    Learn More
  • Last Modified | 04.15.2021

    Person-Centered Support Plans (PCSP) and Functional Assessments (FA) are available for individuals enrolled in the Tennessee Long-Term Services & Supports (LTSS) program. These assessments provide an in-depth evaluation of the needs and services provided to individuals enrolled in the LTSS program. View and download for individuals who are part of TennCare’s LTTS programs (CHOICES and Employment and Community First CHOICES).

    Learn More
Tennessee: Inappropriate Primary/Principle Diagnosis Policy, Facility Update

Last Modified | 04.30.2021

It was previously communicated Oct. 1, 2020, on the Community Plan Portal, that the UnitedHealthcare Community Plan is implementing a new Inappropriate Primary Diagnosis Policy, Facility, for facility claims. Implementation of this new facility policy has been delayed until on or after date of process June 1, 2021.

Learn More
UnitedHealthcare Provider Portal

Last Modified | 04.15.2021

UHCprovider.com and the UnitedHealthcare Community Plan care provider administrative manuals contain helpful information that give you and your staff an easy way to find important topics, such as prior authorization requirements, eligibility verification, claim submission, updated protocols and the TennCare Regulatory Appendix Addendum, as well as other resources and UnitedHealthcare contact information.

Learn More
Summary of 2020 EPSDT Medical Record Review

Last Modified | 04.15.2021

The annual 2020 EPSDT medical record review was conducted for each of the 3 Tennessee grand regions. A total of 45 providers were included in the review, with a total of 135 individual charts reviewed. The average score of all 3 regions combined was 94%. The elements most frequently not documented and identified as opportunities for improvement were Vaccines and Physical Exams. Please refer to the 2020 American Academy of Pediatrics (AAP) and Bright Futures Recommendations for Preventive Pediatric Health Care for current guidelines.

Learn More
Regulatory Appendix Update

Last Modified | 04.15.2021

If you object to this Appendix or no longer wish to participate in our network, you can send us written notice on official letterhead.

Learn More
Person-Centered Support Plans (PCSP) and Functional Assessments (FA) available on Provider Portal

Last Modified | 04.15.2021

Person-Centered Support Plans (PCSP) and Functional Assessments (FA) are available for individuals enrolled in the Tennessee Long-Term Services & Supports (LTSS) program. These assessments provide an in-depth evaluation of the needs and services provided to individuals enrolled in the LTSS program. View and download for individuals who are part of TennCare’s LTTS programs (CHOICES and Employment and Community First CHOICES).

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.

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.