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For UnitedHealthcare Community Plan of Florida

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For UnitedHealthcare Community Plan of Florida

UnitedHealthcare Community Plan of Florida 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 Resources

Current Policies and Clinical Guidelines

Provider Administrative Manual and Guides

EIS Claims Require TL Modifier

For claims submitted on or after April 1, 2020, UnitedHealthcare Community Plan requires that claims for early intervention services (EIS) provided to members include the TL modifier in the first position. This modifier should be added to the codes specified in the applicable EIS, TCM or Therapy Florida Medicaid Fee Schedules.

Find Local COVID-19 Diagnostic Testing Locations

Use these online tools to help find your patients find a COVID-19 diagnostic testing location:

Florida State Supported Testing Sites 
UnitedHealthcare COVID-19 Diagnostic Testing Locator

 

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

Overview

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/FL for current plan names, overview of eligibility information, doctor look up and more.

Member Health Waivers

If you are a provider of a member whose health was previously cared for under one of the following waivers, please contact Provider Services for extra help understanding your full benefit program:

  • Project Aids Care (PAC) Waiver
  • Traumatic Brain Injury (TBI) or Spinal Cord Injury (SCI) Waiver
  • Adult Cystic Fibrosis (ACF) Waiver

You can reach our Provider Services team by calling the number on the back of your members ID card, or by referencing the contact numbers below:

  • Managed Medical Assistance (MMA): 877-842-3210
  • Long Term Care (LTC): 800-791-9233

The best way for primary care providers (PCPs) to view and export the full member roster is using the CommunityCare tool on Link, 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 Link, go to UHCprovider.com/link.

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.  

Current News, Bulletins and Alerts

Medical Policy Documentation Requirement Updates Frequently Asked Questions - UnitedHealthcare Community Plans

Last Modified | 10.20.2020

We’ve refined medical policy documentation requirements and enhanced clinical coverage criteria for various procedures. This document contains information on effective dates by state and frequently asked questions.

Learn More
Inappropriate Primary Diagnosis Policy, Facility - Effective November 1, 2020 - UnitedHealthcare Community Plan of AZ, FL, MD, MI, MS, OH, PA, TN, VA, and WI

Last Modified | 09.29.2020

UnitedHealthcare Community Plan is implementing a new Inappropriate Primary Diagnosis Policy, Facility, for facility claims with dates of services on or after November 1, 2020.

Learn More
Non-Emergent Transportation Vendor Change - Effective Aug. 1, 2020 - UnitedHealthcare Community Plan of Florida

Last Modified | 08.10.2020

Beginning Aug. 1, 2020, LogistiCare is providing non-emergent transportation benefits to our UnitedHealthcare Community Plan and UnitedHealthcare Dual Complete® (D-SNP) members.

Learn More
Treating Atopic Dermatitis - UnitedHealthcare Community Plan of Florida

Last Modified | 08.06.2020

In continuing focus on safe, high-quality and cost-effective care, we're providing this fact sheet as a resource for care providers who are treating patients with atopic dermatitis (AD).

Learn More
Update to Procedure to Modifier Policy for “Always Therapy” Codes – Effective July 1, 2019 for UnitedHealthcare Community Plan of CA, HI, FL, LA, MD, MA, MI, MS, NE, NJ, NY, OH, PA, RI, WA, WI, VA

Last Modified | 05.14.2020

UnitedHealthcare Community Plan is updating its Procedure to Modifier Policy for claims for dates of service on or after July 1, 2019. Physical therapy (GP), occupational therapy (GO) or speech-language pathology (GN) modifiers will be required on “Always Therapy” codes to align with the Centers for Medicare & Medicaid Services (CMS).

Learn More
View More News

Alert for Providers

*  Attention Florida Healthy Kids Providers  *

Important notice: Starting Jan. 1, 2020, there will be changes to Florida Healthy Kids health plans throughout the state. As a result of these changes, our contract with Florida Healthy Kids will expire on Dec. 31, 2019.

Click on this link for more information.

* Alert to Medicaid and Long Term Care Home Care Providers*

Electronic Visit Verification (EVV) has been implemented: Effective 9/01/2019
Applies to Home Health Care, Private Duty Nursing, and Homemaker Companion
Go to 4Tellus.com for more information and to register.
Additional contacts: Provider Advocate or fl_ltc_network@uhc.com or 407-659-7241 

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.