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Community plan (Medicaid)

We offer a variety of low-cost plans for individuals and families to help them get and stay healthy. Our plans cover adults, children, people with disabilities and those who are expecting.

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A monthly notice of recently approved and/or revised Medical Policies and Medical Benefit Drug Policies is provided below for your review. We publish a new announcement on the first calendar day of every month.

The appearance of a health service (e.g., test, drug, device, or procedure) in the Medical Policy Update Bulletin does not imply that UnitedHealthcare provides coverage for the health service. In the event of an inconsistency or conflict between the information provided in the Medical Policy Update Bulletin and the posted policy, the provisions of the posted policy will prevail.

Become part of a network of health care professionals and facilities committed to helping people live healthier lives and making the health care system better for everyone. Select the appropriate service line below for instructions. If you don’t see your specialty, please choose other. 

 

What to have ready 

  • Complete contact information
  • NPI and TIN
  • W-9, if applicable
  • Cultural competency details

 

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NexusACO Referral Requirements Quick Reference Guide
The UnitedHealthcare NexusACO benefit plans offer UnitedHealthcare commercial members a tailored network of accountable care organization (ACO) care providers. In areas where UnitedHealthcare NexusACO doesn’t have a featured ACO, UnitedHealth Premium® Program designated providers will be included as participating Tier 1 care providers.

Charter, Navigate and Navigate Now Referral Requirement Quick Reference Guide
UnitedHealthcare® Charter, Navigate and NavigateNOW benefit plans offer UnitedHealthcare commercial members a customized, more-focused network of healthcare professionals. Some plans require referrals.

Important Concepts in Integration: Coordination of Care
Members may receive services from more than one practitioner. Coordination of Care among practitioners is a best practice, as well as a vital contribution to integrating a member’s physical and behavioral health needs.  

Home Health and SNF High-Performing Provider Initiative Lists
High-Performing Skilled Nursing Facility and Home Health Provider Initiative Lists

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Each United Commercial HMO provider group must receive the provider group's AMP Commercial HMO performance report which shows provider's eligibility for incentive, performance in four appropriate resource use metrics, incentive calculation, and incentive amounts.

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Each United Commercial HMO provider group must receive the provider group's AMP Commercial HMO.

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Each United Commercial HMO provider group must receive the provider group's AMP Commercial HMO performance report which shows provider's eligibility for incentive, performance in four appropriate resource.

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Home and community support services are resources that provide care in individual homes and throughout communities as well as some Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services, including:

  • AAA and ASAP
  • Adult day care/social day care and adult day health care
  • Adult foster care/developmentally disabled group home
  • Assisted care living facility/home
  • Assistive technology supplier
  • Environmental adaptation company
  • Fiscal intermediary
  • Foster care agency
  • Home-delivered meals agency
  • Licensed home care agencies (attendant care, habilitation, homemaker, in-home supportive care, personal care, private duty nursing and respite)
  • Prescribed pediatric extended care centers (pediatric medical day care)
  • Personal emergency response system
  • Pest control company
  • Respite care facility
  • Transition service agency
  • Vehicle modification

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Each United Commercial HMO provider group must receive the provider group's AMP Commercial HMO performance report which shows provider's eligibility for incentive, performance in four appropriate resource use metrics, incentive calculation, and incentive amounts (if achieved) the provider group can anticipate receiving by 2/28/23. 

Required documentation
  • JCAHO, URAC, CHAP or ACHC accreditation
  • Licensure to do business in participation state(s)
  • Medicare enrollment status
  • Community Plan (Medicaid) participation requires proof of enrollment by state 
If your request is declined
If your credentialing is approved, your request will remain on file for a period of 1 year. We will reach out to you if our network needs change. You may submit another request 1 year from the date we declined your request. 

What's new in Network News

Equitable care, better health this Pride Month

Update your profile to show you offer LGBTQ+ supportive services.

Avoid directory removal: Verify your demographic data

We may remove unattested data from the UnitedHealthcare Provider Directory if we can’t verify your information.

June monthly overview

Review the latest UnitedHealthcare prior authorization, medical policy, pharmacy, reimbursement, laboratory and policy and protocol updates.

New Jersey Medicaid: Help ease the strain of rising medication costs

With prescription costs on the rise, explore strategies you can use to help patients manage their medication expenses.

Nominate a deserving attendant for the UnitedHealthcare REACH Award in Texas

Nominate an attendant for the UnitedHealthcare REACH Award by Aug. 31, 2024.

Ohio Medicaid: Balance billing is not permitted

See what steps you can take to stay compliant with balance billing regulations.

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AARP Medicare Advantage from UHC plans cover features and benefits in addition to those included in Original Medicare. Members in some areas may have different plans from which to choose. The plans often include an integrated Medicare Part D prescription drug benefit.


State

2nd language

3rd language

4th language

5th language

6th language

7th language

Arizona

Spanish

Vietnamese

Arabic

Chinese

Persian

-

Florida

Spanish

Creole

-

-

-

-

Hawaii

Chinese

Ilocano (Filipino)

Korean

Vietnamese

Tagalog

-

Indiana

Spanish

-

-

-

-

-

Kansas

Spanish

-

-

-

-

-

Kentucky

Spanish

-

-

-

-

-

Louisiana

Spanish

Vietnamese

Arabic

-

-

-

Maryland

Spanish

Vietnamese

-

-

-

-

Michigan

Arabic

Spanish

Bengali

-

-

-

Minnesota

Spanish

Hmong

Karen

Somali

- -

Mississippi

Spanish

-

-

-

-

 

Missouri

Spanish

-

-

-

-

-

Nebraska

Spanish

Arabic

Vietnamese

-

-

-

New Jersey

Spanish

Korean

Arabic

-

-

-

New York

Spanish

Chinese

Russian

Korean

French

Haida

North Carolina

Spanish

Arabic

Russian Vietnamese - -

Ohio

Spanish

Nepali

Arabic

Somali

Swahili

Burmese

Pennsylvania

Spanish

Arabic

Cambodian

Russian

-

-

Rhode Island

Spanish

Portuguese

-

-

-

-

Tennessee

Spanish

-

-

-

-

 

Texas

Spanish

Vietnamese

-

-

-

-

Virginia

Spanish

Arabic

Vietnamese

Amharic

Persian

Urdu

Washington

Spanish

Russian

Vietnamese

Ukrainian

Chinese

Korean

Wisconsin

Spanish

Hmong

Arabic

Burmese

Somali

Chinese

Additional Plan Information

To learn more about the Medicare Advantage plans offered in your area, visit UHC.com/medicare and enter your ZIP code.

Medicare Part D Information

To learn more about Medicare Part D prescription drug coverage or to access related forms, review the materials available on the Plan Information and Forms page of UHC.com/medicare.

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Designed for what matters most to you

What matters most to you? Managing time? Saving money? Simplifying workflow? Whatever your priority, we offer a variety of digital solutions that can help you complete your tasks quicker and more efficiently.

Average time and costs saved per transaction using digital solutions:

  • Claim Status: 17 minutes and $7.08
  • Eligibility & Benefits: 16 minutes and $5.79
  • Prior Authorization: 11 minutes and $5.18
Source: 2023 CAQH Index, pages 48 and 62 
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