Welcome to the New Home for Care Provider Resources

For UnitedHealthcare Community Plan of Florida

Welcome to the Home for Florida Community Plan Care Provider Resources

For UnitedHealthcare Community Plan of Florida

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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.

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.

Helpful Resources

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

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

Hurricane Matthew Update

Last Modified | 10.10.2018

It is imperative Florida Medicaid recipients maintain access to critical Medicaid services that are life sustaining (examples include: durable medical equipment and supplies, home health services, hospital services, nursing facility services, chemotherapy, dialysis services, etc.) (herein referred to as critical Medicaid services) during the disaster period. To this end, the Agency will ensure reimbursement for critical Medicaid services that are provided in good faith to eligible recipients who reside in the counties impacted by Hurricane Michael.

Learn More
New Cesarean Delivery Reimbursement Policy for UnitedHealthcare Community Plan of Florida

Last Modified | 08.15.2018

UnitedHealthcare Community Plan will implement a new Cesarean Delivery Policy for claims with dates of services on or after Sept. 1, 2018. The policy will reduce reimbursement for cesarean deliveries performed for claims that do not have a supporting diagnosis code.

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UnitedHealthcare Community Plan of Florida Practice Matters - Spring 2018

Last Modified | 07.26.2018

In this issue, you can read about UHCCommunityPlan.com content transitioning to UHCprovider.com, enhancements to Electronic Data Interchange (EDI) claim status transactions, the role of primary care providers in dental prevention, and much more.

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EAPG Rate Error Found for Hospitals and Ambulatory Surgical Centers - UnitedHealthcare Community Plan of Florida

Last Modified | 07.20.2018

An error was discovered in the April 1, 2018, Enhanced Ambulatory Patient Groups (EAPG) rates released by the Agency for Health Care Administration (AHCA). AHCA is currently recalculating the rates, but there’s no timetable for when new rates will be published.

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Billing Tips for Home and Community Based (HCBS) Providers - UnitedHealthcare Community Plan of Florida

Last Modified | 07.05.2018

AHCA requires claims to have the correct care provider data,

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.