Welcome to the Home for Care Provider Resources

For UnitedHealthcare Community Plan of Texas

Welcome

For UnitedHealthcare Community Plan of Texas

Welcome to the Home for Care Provider Resources

For UnitedHealthcare Community Plan of Texas

Welcome

For UnitedHealthcare Community Plan of Texas

UnitedHealthcare Community Plan of Texas 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

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

To Providers: Please update your enrollment and demographic information with TMHP (Texas Medicaid Healthcare Partnership). TMHP is HHSC’s provider enrollment administrator and serves as the authoritative source for HHSC Providers’ enrollment and demographic information. Once you update your enrollment and demographic information with TMHP, your data will be reconciled with the demographic information on file with the MCOs.

To make updates to your current enrollment (e.g., new practice locations or change of ownership updates), please access the web page titled “Provider Enrollment on the Portal - A Step-by-Step Guide” at the following URL: https://www.tmhp.com/sites/default/files/microsites/enrollment/index.html.

For instructions on how to make other demographic updates to your current enrollment, please access the document titled “Provider Information Management System (PIMS) User Guide” at the following URL: https://www.tmhp.com/sites/default/files/file-library/edi/PIMS-user-guide-r2020-11-19.pdf.

Otherwise, you can contact TMHP directly at 800-925-9126 for assistance. 

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

Plan information is available for:

  • Care Improvement Plus Dual Advantage (Regional PPO SNP)
  • Texas STAR
  • Texas STAR Kids
  • Texas STAR+PLUS
  • UnitedHealthcare Community Plan - Children's Health Insurance Program (CHIP)
  • UnitedHealthcare Connected (Medicare-Medicaid Plan)
  • UnitedHealthcare Dual Complete® (HMO SNP) and UnitedHealthcare Dual Complete® (HMO SNP)
  • UnitedHealthcare Dual Complete® (PPO SNP) 

Information available includes:

  • Current plan names
  • Plan details
  • Overvew of eligibility information
  • Member contact information
  • Member Handbook, which includes great information, including:
    • Member rights and responsibilities
    • Member complaints process
    • Member appeals process 

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

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 to determine the right tool to use for your submission.

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.  

Reporting Fraud, Waste or Abuse to the State of Texas

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:

  • Medicaid
  • The Supplemental Nutrition Assistance Program (SNAP, formerly known as Food Stamps)
  • Temporary Assistance for Needy Families (TANF)
  • Women, Infants, and Children (WIC) program
  • The Children's Health Insurance Program (CHIP)

Learn more about how to make a report to Texas Health Human Services.

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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, Alerts and Messages from Texas HHSC

  • 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
  • Last Modified | 10.28.2020

    Correlations between dental and chronic systemic diseases have frequently been reported, particularly with respect to periodontitis with diabetes mellitus type 2 and cardiovascular disease.1 Our child and youth members have dental coverage as a benefit.

    Learn More
  • Last Modified | 10.16.2020

    UnitedHealthcare Community Plan of Texas continually strives to make improvements that can make a difference in our members’ lives. One way we do this is by looking at the following Healthcare Effectiveness Data and Information Set (HEDIS®) measures, which are gathered through a National Committee for Quality Assurance (NCQA) tool that can help find ways to enhance health care.

    Learn More
  • Last Modified | 10.13.2020

    We use complex care management for our members who are living with chronic and/or complex conditions and have a high risk of worsening health and repeat hospitalizations.

    Learn More
  • Last Modified | 09.30.2020

    Many of us take for granted that we can live in our own home.

    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
Dental Prevention - More than Mouth Care

Last Modified | 10.28.2020

Correlations between dental and chronic systemic diseases have frequently been reported, particularly with respect to periodontitis with diabetes mellitus type 2 and cardiovascular disease.1 Our child and youth members have dental coverage as a benefit.

Learn More
Texas Community Plan Quality Newsletter

Last Modified | 10.16.2020

UnitedHealthcare Community Plan of Texas continually strives to make improvements that can make a difference in our members’ lives. One way we do this is by looking at the following Healthcare Effectiveness Data and Information Set (HEDIS®) measures, which are gathered through a National Committee for Quality Assurance (NCQA) tool that can help find ways to enhance health care.

Learn More
Making the Most of Life While Living With Complex Care Needs

Last Modified | 10.13.2020

We use complex care management for our members who are living with chronic and/or complex conditions and have a high risk of worsening health and repeat hospitalizations.

Learn More
Help When and Where It’s Needed

Last Modified | 09.30.2020

Many of us take for granted that we can live in our own home.

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.