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.
For Credentialing and Attestation updates, please contact the National Credentialing Center at 1-877-842-3210.
Learn how to join the Behavioral Health Network, review Community Plan Behavioral Health information, or submit demographic changes at Community Plan Behavioral Health.
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:
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/TX for current member plan information including sample member ID cards, provider directories, dental plans, vision plans and more.
Plan information is available for:
Information available includes:
Member plan and benefit information can also be found at UHCCommunityPlan.com/TX and myuhc.com.
Complaint
The following complaint form can be sent to:
UnitedHealthcare Community Plan
PO Box 31364
Salt Lake City, UT 84131-0364
Claims Reconsiderations and Appeals
A Claims Reconsideration can be completed online faxed. For more information, see UHCProvider.com > Claims & Payments > Submit a Corrected Claim, Claim Reconsideration/Begin Appeals Process.
An appeal can be sent to:
UnitedHealthcare Community Plan
Attn: Complaint and Appeals Dept.
PO Box 31364
Salt Lake City, UT 84131-0364
Appeals can be written in a letter format
The way you submit a referral request depends on the member’s plan. You can use Eligibility and Benefits (on Link) to determine the right tool to use for your submission.
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.
You can report suspected fraud, waste, or abuse by recipients or providers in Texas health and human services programs online or by calling their toll-free fraud hotline. The Texas health and human services system includes:
Learn more about how to make a report to Texas Health Human Services.
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.
Last Modified | 02.25.2021
Starting April 1, 2021, prior authorization will be required for some drugs used to treat “off” episodes (when a dose wears off) in members with advanced Parkinson’s disease, side effects caused by other drugs used for Parkinson’s disease and drugs used as an oral corticosteroid with other anti-myeloma products for adults with multiple myeloma (MM) when prescribed to UnitedHealthcare Community Plan members.
Learn MoreLast Modified | 02.22.2021
An Important Message from The Texas Health and Human Services Commission (HHSC): EVV Policy Update: 180 Day & 90 Day Visit Maintenance Temporary Policy
Learn MoreLast Modified | 02.11.2021
Claims clarification: Taxonomy codes required UnitedHealthcare Community Plan in Texas is sharing this information from the Texas Health and Human Services Commission so you know what the state requires
Learn MoreLast Modified | 02.08.2021
HHSC will continue to maintain Medicaid coverage until the federal COVID-19 PHE ends for members who would otherwise be determined ineligible.
Learn MoreLast Modified | 02.08.2021
The processes outlined below do not apply to STAR Kids who are not in a waiver and/or not receiving PPECC or PDN.
Learn MoreLast Modified | 02.25.2021
Starting April 1, 2021, prior authorization will be required for some drugs used to treat “off” episodes (when a dose wears off) in members with advanced Parkinson’s disease, side effects caused by other drugs used for Parkinson’s disease and drugs used as an oral corticosteroid with other anti-myeloma products for adults with multiple myeloma (MM) when prescribed to UnitedHealthcare Community Plan members.
Learn MoreLast Modified | 02.22.2021
An Important Message from The Texas Health and Human Services Commission (HHSC): EVV Policy Update: 180 Day & 90 Day Visit Maintenance Temporary Policy
Learn MoreLast Modified | 02.11.2021
Claims clarification: Taxonomy codes required UnitedHealthcare Community Plan in Texas is sharing this information from the Texas Health and Human Services Commission so you know what the state requires
Learn MoreLast Modified | 02.08.2021
HHSC will continue to maintain Medicaid coverage until the federal COVID-19 PHE ends for members who would otherwise be determined ineligible.
Learn MoreLast Modified | 02.08.2021
The processes outlined below do not apply to STAR Kids who are not in a waiver and/or not receiving PPECC or PDN.
Learn MoreHIPAA 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.
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.
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.