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.
Effective January 1, 2022, UnitedHealthcare Community Plan will cover the Major Organ Transplant (MOT) benefit including related services such as organ procurement and living donor care.
Please direct your inquiries to UnitedHealthcare Community Plan at 1-866-270-5785 available Monday-Friday from 8:00 a.m. - 5:00 p.m. PST.
1-866-270-5785 available Monday-Friday from 8:00 a.m.-5:00 p.m. PST
UnitedHealthcare Community Plan of California, Inc.
4365 Executive Drive, Suite 500
San Diego, CA 92121
UnitedHealthcare Community Plan of California, Inc.
8880 Call Center Drive, Suite, 300
Sacramento, CA 95826
UnitedHealthcare Community Plan of California, Inc.
P.O. Box 30884
Salt Lake City, UT 84130-0884
UnitedHealthcare Community Plan of California, Inc.
Attention: Provider Dispute
P.O. Box 31364
Salt Lake City, UT 84131
UnitedHealthcare Community Plan of California, Inc.
Attention: Grievance and Appeals
P.O. Box 31364
Salt Lake City, UT 84131-0364
California Advancing and Innovating Medi-Cal (CalAIM) establishes the framework to address social determinants of health and improve health equity statewide.
A key feature of CalAIM is the introduction of a menu of in lieu of Community Supports.
What Are Community Supports?
Community Supports are services or settings that the Plan may offer in place of services or settings covered under the California Medicaid State Plan and that are medically appropriate, cost-effective alternatives to a State Plan covered service.
Community Supports are optional for the Plan to offer and for Members to utilize. The Plan will not require Members to use Community Supports instead of a service or setting.
Community Supports that may be offered are:
For more information, call Member Services at 1-877-650-1477 (TTY 711)
For Credentialing and Attestation updates, contact the National Credentialing Center at 1-877-842-3210.
UnitedHealthcare Community Plan of California and Solera are working together to offer a Diabetes Prevention Program at no cost to qualified members. Solera is a health care solutions company that specializes in managing cost-effective health programs using technology and disease prevention program strategies.
The Diabetes Prevention Program can help members make small changes to live healthier lives, lose weight and help lower their chance of developing type 2 diabetes.
This program is geared towards members who:
Because UnitedHealthcare is working directly with Solera, your patients who are UnitedHealthcare members may be eligible to enroll in the program at no cost to them. You can refer a member to enroll in the program and, if the member qualifies, they’ll have access to weekly sessions, small group support, personal health coaches and more.
For more information, call Solera at 877-486-0141, TTY 711, Monday – Friday, 6 a.m. – 6 p.m. Pacific Time.
UnitedHealthcare Community Plan of California, Inc. covers Enhanced Care Management (ECM) services for members with highly complex needs. ECM is a benefit that provides extra services to help you get the care you need to stay healthy. It coordinates the care you get from different doctors. ECM helps coordinate primary care, acute care, behavioral health, developmental, oral health, community-based long-term services and supports (LTSS), and referrals to available community resources.
If you qualify, you may be contacted about ECM services. You can also call UnitedHealthcare Community Plan of California, Inc. to find out if and when you can receive ECM. Or talk to your health care provider who can find out if you qualify for ECM and when and how you can receive it.
Covered ECM services
If you qualify for ECM, you will have your own care team, including a care coordinator. This person will talk to you and your doctors, specialists, pharmacists, case managers, social services providers and others to make sure everyone works together to get you the care you need. A care coordinator can also help you find and apply for other services in your community. ECM includes:
To find out if ECM may be right for you, talk to your UnitedHealthcare Community Plan of California, Inc. representative or health care provider.
Call Member Services at 1-833-940-3465 (TTY 711).
UnitedHealthcare Community Plan of California, Inc. is here 7:00 a.m. to 7:00 p.m. PST, Monday through Friday, except State holidays. The call is toll free. Or call the California Relay Line at 711. Visit online at myuhc.com/CommunityPlan.
UnitedHealthcare is here to help your practice successfully transition to the integrated care clinical model.
If you have any questions, please contact the community integration team at CAintegratedcare@uhc.com.
For more training and educational resources, please visit Training and Education on the UnitedHealthcare California Community Home Page.
Learn how to join the Behavioral Health Network, review Community Plan Behavioral Health information, or submit demographic changes at Community Plan Behavioral Health.
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:
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/CA for current member plan information including 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/CA and myuhc.com/communityplan.
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.
UnitedHealthcare Community Plan of California conducts a Population Needs Assessment (PNA) on an annual basis. The goal of this analysis is to:
Access the most recent report: UHC Population Needs Assessment RY 2021
Search for a care provider by plan name:
Please complete the form below and mail it to the address provided to address concerns.
The UnitedHealthcare Community Plan of California Quality Improvement Program assesses the overall effectiveness of our health plan, including processes, goals and outcomes related to member care and services. If you’d like to request a copy of our Quality Improvement Program Annual Evaluation, please email uhccscaqualitydepartment_dl@ds.uhc.com.
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.
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.