Details on UnitedHealthcare Community Plan of California
Online tools and resources to verify eligibility, submit claims and more
Best practices for claims submission and timely filing
Prior authorization requirements and process
How to resolve issues by reaching out to the right contacts
How to access quick reference guides for answers to common questions
Initial Health Assessment Training
Per California Department of Health Care Services (DHCS) Policy Letter 08-003, the Initial Health Assessment (IHA) is a comprehensive assessment that is completed during the member’s initial encounter(s) with a select or assigned primary care physician (PCP), appropriate medical specialist, or non-physician medical provider (Nurse Practitioner, Certified Nurse Midwives, Physician Assistants and Primary Care Providers in training) and must be documented in the member’s medical record.
The IHA enables the members PCP to assess and manage the acute, chronic and preventive health needs of the member. The IHA must be completed and documented in medical record within 120 calendar days of the member’s enrollment to UnitedHealthcare Community Plan.
Review the Timely Access to Care Standards and share them with your staff.
Timely Access to Care Standards
The California Department of Managed Health Care requires that appointment requests are completed within specific timeframes. Following these standards guarantees that patients have timely access to care.
We want to make sure our care providers are following the timely access to care standards. Each year, we ask certain care providers to complete a Patient Access and Availability Study. UnitedHealthcare Community Plan of California closely monitors grievance reports to identify access and availability issues. Issues will be tracked and, if a trend is identified, it may result in an Improvement Action Plan.
In 2020, UnitedHealthcare Community Plan of California conducted a care provider appointment availability survey to make sure our care providers are following the California Department of Managed Health Care (DMHC) requirements for these services.
OptumHealth & Optum Provider Express Training & Resources
OptumHealth Education and Optum Provider Express offer a variety of informational webinars and training resources for providers. Training classes, guides and resources are added frequently.
OptumHealth Education (Last Modified 06.08.2018) - OptumHealth Education offers accredited, on-demand webcasts and information regarding upcoming conferences for both physical and behavioral health providers. Some activities include Disease Management, Autism Spectrum Disorder, Behavioral Health, Intellectual and Developmental Disabilities.
Provider Express Webinars & Training Resources - Optum Provider Express offers informational webinars and training resources for providers to learn more about how to use the website and other topics that may be vital to your practice.
Online training for Behavioral Health Providers is available under “UnitedHealthcare Community Plan Prior Authorization Training for Behavioral Health Providers”.
Provider Express Training & Guided Tours - Optum Provider Express offers guided training about prior authorization, eligibility and benefits, and claims (claim entry, corrected claims, claim inquiry, etc.). First-time user training is available as well as a technical resource guide.
Requirements for Blood Lead Screening
Per California Department of Health Care Services (DHCS) Policy Letter 20-016, federal law requires care providers to screen children enrolled in Medicaid for elevated blood lead levels (BLLs) as part of required prevention services offered through the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program.
Screening Requirements for Autism Spectrum Disorder
Per California Department of Health Care Services (DHCS) Policy Letter 18-006, federal law requires care providers to screen children younger than 21 who are enrolled in Medi-Cal for autism spectrum disorder. This requirement is part of the Center for Medicare & Medicaid Services (CMS) Early and Periodic Screening, Diagnostic and Treatment (EPSDT) guidelines.
When screening children for autism spectrum disorder, we recommend administering the Ages and Stages Autism Screening Questionnaire – Third Edition (ASQ®-3). You can request a hard copy of the ASQ-3 by emailing email@example.com.
Additional Training & Resources
Our Healthcare Professional Education and Training page is your source for on-demand education created specifically for UnitedHealthcare providers. It gives you in-depth information and meaningful updates from UnitedHealthcare 24/7 and can be accessed from any device.
Claims and Payments: Get the most recent claims processing information.
Link Tutorials: Tutorials will quickly get you up to speed with our online self-service tools.
State-Specific Information: Each state has its own page for state-specific information and resources.