UnitedHealthcare Community Plan of District of Columbia 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. Enrollees must have Medicaid to enroll.
Per the UnitedHealthcare contract with the Department of Health Care Finance, we will adhere to the continuity of care period requirements. This will help ensure that UnitedHealthcare Community Plan enrollees continue to have access to Medicaid and long-term services and supports (LTSS) services and can safely maintain their placement in the community.
UnitedHealthcare Community Plan determines and maintains its list of covered medications. This list applies to all UnitedHealthcare Community Plan of District of Columbia members.
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/DC or current member plan information including sample member ID cards, provider directories, dental plans, vision plans and more.
The best way for primary care professionals (PCPs) to manage District of Columbia UnitedHealthcare Community Plan and UnitedHealthcare Dual Complete member care is using the Care Conductor tool on the UnitedHealthcare Provider Portal, which allows PCPs to:
View a member’s plan of care and health assessment
Enter plan notes and view notes history for some plans
The best way for primary care professionals (PCPs) to view and export the full District of Columbia UnitedHealthcare Community Plan and UnitedHealthcare Dual Complete member roster is using the CommunityCare feature on the UnitedHealthcare Provider Portal, which allows PCPs to:
See a complete list of all members, or members added in the last 30 days
Export the roster to Excel
Access information about patients admitted to or discharged from an inpatient facility
Access information about patients seen in an Emergency Department
Physician Administered Drugs, Medical Injectables and Specialty Pharmacy
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, 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.
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.