Last Update: May 1, 2021 8:00 a.m.
Information contained in the topics below provides information, resources, and links to help practitioners support our Community and State members and our Quality programs.
UnitedHealthcare Community Plan has appointment accessibility requirements for primary care practitioners and specialists. The requirements apply to routine, urgent and after-hours care.
For more information, please refer to your Care Provider Manual.
The UnitedHealthcare Community Plan Case Management program is a holistic approach to care for members with complex needs, especially for those with chronic conditions. The goal is to keep our members in the community with the resources necessary to maintain the highest functional status possible.
What can the UnitedHealthcare Community Plan Case Manager provide for your patients?
How to Refer:
For more information or to make a referral, call our referral line at 877-542-9235.
Clinical Practice Guidelines (CPG) for UnitedHealthcare Community Plan are available at UHCprovider.com > Menu > Health Plans by State > [Select State]. Guidelines are available for diabetes, asthma, perinatal care, preventive services, ADHD, depression, and many other conditions. Click on your appropriate state and there will be a link to the currently approved CPGs. Or, you may call 877-542-9235 for a copy.
UnitedHealthcare Community Plan wants to underscore the importance of ongoing communication between primary care practitioners (PCP) and specialists. PCPs and specialists share responsibility for communicating essential patient information regarding consultations, treatment plans and referrals.
Failure to consistently communicate threatens the ability to provide high-quality patient care.
Relevant information from the PCP should include the patient's history, diagnostic tests and results, and the reason for the consultation. The specialist is responsible for timely communication of the results of the consultation and ongoing recommendations and treatment plans.
The information exchange between practitioners should be timely, relevant and accurate to facilitate ongoing patient management. The partnership between the PCP and specialist is based on the consistent exchange of clinical information is a critical part of providing quality patient care.
To help reduce those gaps and improve culturally competent care, we want you to know that UnitedHealthcare Community Plan’s members have a right to receive care that is culturally appropriate and respects their cultural and ethnic background and origins. Upon enrollment, information regarding a member’s primary language is obtained and members may receive assistance in choosing a primary care provider who will meet their needs.
UnitedHealthcare Community Plan provides access to a language line for translation of communications for our non- English speaking members. The language line is available to help ensure that the cultural, ethnic and linguistic needs of our members are being met.
If you need assistance in communicating with 1 of our members you may call customer service for assistance at 877-542-9235.
Just a reminder, the United Healthcare Community Plan Member Rights and Responsibilities can be found in the Care 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.
UnitedHealthcare Community Plan pharmacy updates are available at UHCprovider.com > Menu > Health Plans by State > Select State > Medicaid (Community Plan) > Pharmacy Resources and Physician-Administered Drugs.
You can find this information online:
For more information, call the pharmacy hotline 800-922-1557.
UnitedHealthcare Community Plan serves a diverse group of individuals and each state has unique membership that has its own cultural and language needs. Information about our membership is collected and analyzed in order to provide our members with services that meet their individual cultural and language needs.
Following are examples of some of our diverse membership by state:
We support our practitioners in their efforts to provide culturally appropriate care by providing cultural competency training and language services to effectively communicate with our members.
Language assistance is available to help providers communicate with members. Services include a telephone language line, in-person interpreters, and video services.
We also have tools to promote cultural awareness and assist practitioners in recognizing and treating health disparities. They’re available online at UHCprovider.com > Menu > Resource Library > Patient Health and Safety > Cultural Competency.
The website includes training on cultural competency and the Americans with Disabilities Act, continuing education and cultural competency resources.
You may also call 877-542-9235 to get more information on how to obtain language assistance and interpreter services for our members.
UnitedHealthcare Community Plan staff performs concurrent review on inpatient stays in acute, rehabilitation and skilled nursing facilities, as well as prior authorization reviews of selected services. The Prior Authorization and Notification tool provides a listing of services that require prior authorization. You can learn more about the tool at UHCprovider.com/PAAN. Training is available in the Videos and Training section of the web site.
A physician reviews all cases in which the care does not appear to meet guidelines. Decisions regarding coverage are based on the appropriateness of care and service and existence of coverage. We do not provide financial or other rewards to our physicians for issuing denials of coverage or for underutilizing services.
If you have questions or would like specific UM criteria, you can talk to our staff. Call toll-free 877-542-9235. Staff is available 8 hours per day from 9 a.m.—5 p.m. Eastern Time.