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UnitedHealthcare Community Plan of Hawaii Homepage

Aloha and welcome! 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 QUEST Integration Program

Hours of Operation

Monday - Friday, from 7:45 a.m. - 4:30 p.m. Hawaiian Standard Time (HST) 

Health Plan Administrative Office

1132 Bishop Street., Suite 400
Honolulu, HI 96813
Phone: 1-808-535-1000 

Provider / Member Services Information

Call Center

  • 1-888-980-8728
  • Medicare Advantage-Dual Special Needs Program (MA-DSNP): 1-866-622-8054
  • TTY: 711 (Hearing Impaired)

Prior Authorization

  • 1-888-980-8728
  • TTY: 711 (Hearing Impaired)
  • Fax: 1-800-267-8328

Claims Mailing Address

UnitedHealthcare CommunityPlan QUEST Integration
P.O. Box 31365
Salt Lake City, UT 84131-0365
Payer ID#: 87726 (EDI Claims Submission)

For ERA, use Payer ID# 04567 

Behavioral Health Services Information

Call Center

  • 1-888-980-8728
  • Medicare Advantage-Dual Special Needs Program (MA-DSNP): 1-866-622-8054
  • TTY: 711 (Hearing Impaired)

Prior Authorization

Fax: 1-877-840-5581
Website: www.providerexpress.com 

Claims Mailing Address

Optum
P.O. Box 30757
Salt Lake City, UT 84130-0757
Payer ID#: 87726 (EDI Claims Submission)

For ERA, use Payer ID# 04567 

Pharmacy Contact Information

  • 1-888-980-8728
  • TTY: 711 (Hearing Impaired)

Prior Authorization Phone: 1-800-310-6826
Prior Authorization Fax: 1-866-940-7328
Help Desk Phone: 1-800-797-9791
Bioscrip-Specialty Drug Phone: 1-800-584-0265
Formulary Information:  uhccommunityplan.com/hi.html 

Transportation Services Contact Information

Reservations: 1-866-475-5744
Ride Assistance: 1-866-475-5745
TTY (Heaing Impaired): 1-866-288-3133 

Other Resources

Providers should contact Provider Services at 1-888-980-8728 to start the credentialing and attestation process.

All providers are credentialed through MDX Hawaii except for the following:

  • Behavioral Health Providers are credentialed by Optum.
  • Home and Community Based Service (HCBS) providers are credentialed by UnitedHealthcare. 

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 Administrative Guide

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.

Resources

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

Plan information is available for:

  • Hawaii UnitedHealthcare Community Plan QUEST Integration Program

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

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

Practice Matters Newsletter - Summer 2018 - UnitedHealthcare Community Plan of Hawaii

Last Modified | 07.11.2018

Practice Matters includes important information for UnitedHealthcare Community Plan health care professionals and facilities.

Learn More
Practice Matters Newsletter - Winter 2018 - UnitedHealthcare Community Plan of Hawaii

Last Modified | 07.11.2018

Practice Matters includes important information for UnitedHealthcare Community Plan health care professionals and facilities.

Learn More
Specialty Pharmacies to Use for Rare or Complex Diseases, Starting April 17, 2017

Last Modified | 06.27.2018

UnitedHealthcare’s Specialty Pharmacy Program helps our members effectively manage rare or complex diseases and make the most of their benefits by giving them access to the right specialty medications, programs and support. Starting April 17, 2017, the following specialty pharmacy medications will need to be filled by a specialty pharmacy in OptumRx’s Specialty Network for QUEST Integration.

Learn More
Frequently Asked Questions about Transition to Enhanced Enrollment and Claims Payment System

Last Modified | 06.27.2018

The following frequently asked questions and answers will help care providers and their staff when UnitedHealthcare Community Plan of Hawaii transitions to an enhanced enrollment and claims payment system on Jan. 1, 2017.

Learn More
New National Drug Code Requirement Policy: Effective for Claims With Date of Service On Or After May 1, 2017

Last Modified | 06.27.2018

Effective for claims with a date of service on or after May 1, 2017, we will be implementing a new National Drug Code (NDC) Requirement reimbursement policy. Claims submitted for reimbursement for drug-related codes for UnitedHealthcare Community Plan members must include NDC number, NDC unit of measure and NDC units dispensed.

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.