As of January 1, 2021, AHCCCS implemented EVV for non-skilled in-home services (attendant care, personal care, homemaker, habilitation, respite) and for in-home skilled nursing services (home health). Important changes include the elimination of paper timesheets. Hard Claim Edits begin January 1, 2023. Visit the AHCCCS website to learn more about what these changes mean for you.
NOTE: As of Aug. 1, 2022, changes have been made by AHCCCS to the required service codes in scope for EVV.
Remember to sign up for the AHCCCS Electronic Visit Verification (EVV) Constant Contact distribution https://www.azahcccs.gov/AHCCCS/Initiatives/EVV/index.html?id=StayInformed list to receive important updates and notifications.
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.
ACC/DD/Dual Complete One Provider Call Center
1-800-445-1638, available from 8:00 a.m. - 5:00 p.m. Arizona Time
LTC Provider Call Center
1-800-293-3740, available from 8:00 a.m.- 5:00 p.m. Arizona Time
Arizona Provider Relations Physician & Hospital Advocate Team
Email: westprteam@uhc.com for claims issues
Include health care professional / facility name, contact name & phone number, any tracking / reference numbers, TIN, and brief description of issue.
Arizona Therapy Provider Resolution Team
Email: netdevpubsec@optum.com for claims issues
Include “NPC (AZ)”/ Name/TIN/examples and a brief description of issue.
Fee Schedules: myoptumhealthphysicalhealth.com > Tools and Resources > Fee Schedules
Therapy Provider Call Center: 800-873-4575
Mailing Address
UnitedHealthcare Community Plan
1 East Washington, Suite 900
Phoenix, AZ 85004
Claims & Medical Records Mailing Address
UnitedHealthcare Community Plan
PO Box 5290
Kingston, NY 12402-5290
Behavioral Health Claims & Medical Records Mailing Address
United Behavioral Health
PO Box 30760
Salt Lake City, UT 84130-0760
Provider Claim Disputes Mailing Address
UnitedHealthcare Community Plan
Attn: Provider Claim Disputes
1 East Washington, Suite 900
Phoenix, AZ 85004
UnitedHealthcare Dual Complete One (HMO-SNP) Provider Claim Disputes Mailing Address
UnitedHealthcare Dual Complete
Attn: Provider Claim Disputes
PO Box 31364
Salt Lake City, UT 84131-0364
UnitedHealthcare Dual Complete One (HMO-SNP) Part C Member Appeals and Grievance Department
Attn: CA124-0187
PO Box 6103
Cypress, CA 90630-0023
UnitedHealthcare Dual Complete One (HMO-SNP) Part D Member Appeals and Grievance Department
Attn: CA124-0197
PO Box 61063
Cypress, CA 90630
For more information about the credentialing process for network care providers, please read the AHCCCS Credentialing Tip Sheet. You can also visit UHCprovider.com/join > Step 2: Get Credentialed for additional credentialing resources and information.
For Credentialing and Attestation updates, contact the National Credentialing Center at 1-877-842-3210.
Member dental plan and benefit information can be found at UHCCommunityPlan.com/AZ and myuhc.com.
Dental practitioners that are currently serving Mediciad plans can access Community & State dental information by logging into uhcdental.com under Community & State.
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.
Overview
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/AZ for current member plan information including member handbooks, sample member ID cards, provider directories, dental plans, vision plans and more.
Plan information is available for:
Member plan and benefit information can also be found at UHCCommunityPlan.com/AZ and myuhc.com/communityplan.
Member Eligibility
Verifying Member Eligibility through AHCCCS Online / State of Arizona
The Division of Developmental Disabilities services are based on age and specific eligibility based on federal requirements and referral/application processes. Click here for details.
The best way for primary care providers (PCPs) to view and export the full member roster is using the CommunityCare tool, which allows you to:
For help using CommunityCare, please see our Quick Reference Guide. If you’re not familiar with our portal, go to UHCprovider.com/portal.
Check out Care Conductor in the UnitedHealthcare Provider Portal under Clinical & Pharmacy.
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.
How to Report Fraud, Waste or Abuse to the State of Arizona
The Office of Inspector General for the State of Arizona provides a way for members, plans, providers, and the public to report all forms of suspected fraud, waste or abuse of the program. We encourage medical professionals and their staff to review the information available on the AHCCCS website.
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.
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.
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.