UnitedHealthcare Community Plan of Arizona Homepage

Electronic Visit Verification now required for personal care and home health services

As of Jan. 1. 2021, AHCCCS has implemented Electronic Visit Verification (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. Visit the AHCCCS website to learn more about what these changes mean for you. 

Effective April 15, 2021, authorizations are required for non-COVID-19-related services for acute inpatient hospitalizations. You can submit your requests through the Prior Authorization and Notification Tool.

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

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AHCCCS Complete Care (ACC) / Developmental Disabilities (DD) / Long Term Care (LTC) / Dual Complete One (HMO-SNP) Medicaid Contact Information

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.

UnitedHealthcare Dental Provider Portal

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:

  • 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/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:

  • Arizona Complete Care / Medicaid
  • Arizona Developmentally Disabled (DD)
  • Arizona Long Term Care 

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:  

  • Identify Medicaid recipients who need to have their Medicaid recertification completed and approved by the State Agency in order to remain eligible to receive Medicaid benefits
  • See a complete list of all members, or just members added in the last 30 days
  • Export the roster to Excel
  • View most Medicaid and Medicare SNP members’ plans of care and health assessments
  • Enter plan notes and view notes history (for some plans)
  • Obtain HEDIS information for your member population
  • Access information about members admitted to or discharged from an inpatient facility
  • Access information about members seen in an Emergency Department

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 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, Bulletins and Alerts

Last Modified | 06.16.2022

New tracking requirments for CALOCUS training and guidelines for who needs to complete the training.

Learn More

Last Modified | 06.03.2022

We will no longer send paper checks for claim payments to Community Plan health care professionals in Arizona.

Learn More

Last Modified | 05.31.2022

Arizona Medicaid: Required courses for health care professionals serving children in the Arizona CSOC

Learn More

Last Modified | 05.16.2022

Health care professionals who wish to contract with UnitedHealthcare Community Plan may need a site visit as part of the credentialing process.

Learn More

Last Modified | 04.29.2022

Effective Aug. 1, 2022, Optum will manage prior authorization requests for non-oncology injectable medications that are covered on the medical benefit for UnitedHealthcare Community Plans.

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.

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.