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 for Mental Health and Substance Use Issues
  
• Cultural Competency Library
• How to Submit Supporting Documentation for Unprocessed Claims - NEW!
• MARCH Vision Care
• Optum Rx
• Texas Department of Family and Protective Services
• Texas Department of Family and Protective Services Policies
• Texas Department of State Health Services - Texas Health Steps Provider Page
• Texas Health and Human Services Commission
• Texas Health Steps Regional Representatives Contact List
• Texas HHSC Nursing Facility Unit Rates
• Texas Medicaid and Healthcare Partnership (TMHP)
• Texas Office of Consumer Credit Commissioner Guide to Financial Literacy and Education Resources
• Think Cultural Health
• UnitedHealthcare Dental

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

• Provider Complaint Form

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

Search for a care provider by plan name: 

• Children's Health Insurance Program (CHIP)
• STAR
• STAR Kids
• STAR+PLUS
• UnitedHealthcare Connected® (Medicare-Medicaid Plan)
• UnitedHealthcare Dual Complete® (HMO SNP) and UnitedHealthcare Dual Complete® (HMO SNP)
• UnitedHealthcare Dual Complete® (PPO SNP) 

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

• Attendant Compensation Rate Enhancement Request Form - The application deadline for the rate enhancement is Nov. 1, 2020 at 5:00 p.m. CST.
• Critical Incident Reporting Form
• EVV Visit Maintenance Unlock Request Form
  
• TX Online Complaint Form for STAR Kids 
• Obstetrics / Pregnancy Risk Assessment Form
• Pregnancy Notification Form
• Prior Authorization Forms
  
• Provider Complaint Form
• Texas Health Steps Medical Checkup Child Health Records By Age: Helping Make Component Documentation Easier

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.