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UnitedHealthcare Community Plan of Delaware 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.

NOTICE: As of January 1st, 2018 UnitedHealthcare Community Plan will no longer provide Medicaid and Long Term Care coverage in Delaware.

For questions about 2018 services, members can call their new Health Plan Member Service’s phone number, it is on their ID card. If members have questions related to any services prior to January 1, 2018, members can call United Healthcare Community Plan member services at 1-877-877-8159

This change doesn’t affect UnitedHealthcare Medicare, including Institutional Special Needs Plan (I-SNP) and Dual Complete Plan (DSNP) or UnitedHealthcare Commercial Plan members.

Healthcare Providers can continue to call Provider Services at 1-800-600-9007.  For questions regarding behavioral health, please call 1-877-614-0484.  For questions regarding Dental, please call 1-855-609-5152.

For Credentialing and Attestation updates, contact the National Credentialing Center at 1-877-842-3210.

Facility/Hospital-Based Providers, Group/Practice Providers and Individually-Contracted Clinicians

Learn about requirements for joining our network.

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.

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.

Resources

Visit UHCCommunityPlan.com/DE for current member plan information including sample member ID cards, provider directories, dental plans, vision plans and more.

Plan information is available for:

  • Delaware UnitedHealthcare Community Plan
  • Delaware UnitedHealthcare Community Plan - Long Term Care

Member plan and benefit information can also be found at UHCCommunityPlan.com/DE and myuhc.com.

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Claims Reconsiderations/Adjustments

To view up to date Claim Reconsideration information go to UHCprovider.com.

Claim Administrative Disputes/Appeals

If you are not satisfied with the outcome of a Claim Reconsideration Request, you may submit a formal Claim Dispute/Appeal using the process outlined in your provider manual.

A formal Claim Dispute/Appeal is a comprehensive review of the disputed claim(s), and may involve a review of additional administrative or medical records by a clinician or other personnel.

UnitedHealthcare Community Plan generally completes the review within 30 calendar days. However, depending on the nature of the review, a decision may take up to 60 days from the receipt of the claim dispute documentation. We will contact you if we believe it will take longer than 30 days to render a decision.

Please allow 10 business days from the submission date to enable us to begin processing the review before requesting a status update.

Additional state requirements may apply. Consult the applicable state Provider Administrative Guide or Manual for more details.

For more information please contact the provider services center.

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, UnitedHealthcare works to detect, correct and prevent fraud , waste  and abuse  in the health care system.

Call us at 1-844-359-7736 or at uhc.com/fraud to report any issues or concerns. 

Current News, Bulletins and Alerts

UnitedHealthcare Community Plan of Delaware Practice Matters - Winter 2016

Last Modified | 07.26.2018

We hope you enjoy the winter edition of Practice Matters. In this issue, you can read about the enhanced eligibilityLink app, virtual card payment options, where to get pharmacy updates and much more.

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UnitedHealthcare Community Plan of Delaware Practice Matters - Spring 2016

Last Modified | 07.26.2018

We hope you enjoy the spring edition of Practice Matters. In this issue, you can read about fluoride varnish reimbursement, Electronic Payments & Statements, disease management, and much more. Happy spring!

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UnitedHealthcare Community Plan of Delaware Practice Matters - Summer 2016

Last Modified | 07.26.2018

We hope you enjoy the summer edition of Practice Matters. In this issue, you can read about detecting depression in primary care, promoting oral health for long-term care members, coordination of care and much more. Happy summer!

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UnitedHealthcare Community Plan of Delaware Practice Matters - Fall 2016

Last Modified | 07.26.2018

We hope you enjoy this edition of Practice Matters. In this issue, you can read about new and updated Link applications, a new Dual Special Needs Plan, promoting oral health for long-term care members and more.

Learn More
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HEDIS Medical Record Collection

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. View our updated HIPAA information for UnitedHealthcare Community Plan.

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.