Welcome to the Home for Care Provider Resources

For UnitedHealthcare Community Plan of California

Welcome

For UnitedHealthcare Community Plan of California

Welcome to the Home for Care Provider Resources

For UnitedHealthcare Community Plan of California

Welcome

For UnitedHealthcare Community Plan of California

UnitedHealthcare Community Plan of California Homepage

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

Current Policies and Clinical Guidelines

Provider Manual and Guides

Major Organ Transplants (MOT) Requirements

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.

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Provider Call Center

1-866-270-5785 available Monday-Friday from 8:00 a.m.-5:00 p.m. PST

Mailing Addresses

San Diego County

UnitedHealthcare Community Plan of California, Inc.
4365 Executive Drive, Suite 500
San Diego, CA 92121

Sacramento County

UnitedHealthcare Community Plan of California, Inc.
8880 Call Center Drive, Suite, 300
Sacramento, CA 95826

Claims & Medical Records Mailing Address

UnitedHealthcare Community Plan of California, Inc.
P.O. Box 30884
Salt Lake City, UT 84130-0884

Provider Disputes Mailing Address

UnitedHealthcare Community Plan of California, Inc.
Attention: Provider Dispute
P.O. Box 31364
Salt Lake City, UT 84131

Member Grievance & Appeals

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:

  • Housing Transition and Navigation Services
  • Housing Deposits
  • Housing Tenancy and Sustaining Services
  • Short-Term Post-Hospitalization Housing
  • Recuperative Care (Medical Respite)
  • Respite Services
  • Medically Supportive Food/ Meals/Medically Tailored Meals
  • Sobering Centers

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.

How it Works

This program is geared towards members who:

  • May need extra support in managing their eating and exercising habits
  • Had a recent health screening and shows signs of concern for pre-diabetes
  • Has family members with type 2 diabetes

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.

How to Refer a Member

  • You can ask the member to take a one-minute quiz at solera4me.com/UHC and review their results to see if they would benefit from this type of personalized support. Members can also call 888-305-6015 for more information or to take the one-minute quiz over the phone.
  • If you’d like additional updates on a member’s progress within the program please contact the Quality Department, Health Education and Cultural Linguistics Programs at uhchealthed@uhc.com.

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:

  • Outreach and engagement
  • Comprehensive assessment and care management
  • Enhanced coordination of care
  • Health promotion
  • Comprehensive transitional care
  • Member and family support services
  • Coordination and referral to community and social supports

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.

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

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/CA for current member plan information including sample member ID cards, provider directories, dental plans, vision plans and more.

Plan information is available for:

  • UnitedHealthcare Community Plan of California - Medi-Cal

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:  

  • 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.

UnitedHealthcare Community Plan of California conducts a Population Needs Assessment (PNA) on an annual basis. The goal of this analysis is to:

  • Identify member health needs and health disparities
  • Evaluate health education, cultural and linguistic services, quality improvement activities, and resources available to members
  • Implement targeted strategies for programs and services

Access the most recent report: UHC Population Needs Assessment RY 2021

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

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. 

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 | 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.

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Last Modified | 03.29.2022

A list of UnitedHealthcare Community Plan members who have yet to receive a required blood screening is now included in the Patient Care Opportunity Report (PCOR).

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Last Modified | 07.09.2021

UnitedHealthcare Community Plan network providers will have the opportunity to share their feedback about their experience working with us by taking our Physician Satisfaction Survey. This survey applies to physicians who participate in Medicaid.

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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.