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.
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.
Learn how to join the Behavioral Health Network, review Community Plan Behavioral Health information, or submit demographic changes at Community Plan Behavioral Health.
Medicaid Managed Care Rule
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.
Member Information: Current Medical Plans, ID Cards, Provider Directories, Dental & Vision Plans
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
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 Health Care Fraud, Waste and Abuse
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.
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.
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.