UnitedHealthcare Community Plan of Hawaii Homepage
Hawaii: Registration requirement for Medicaid providers The Hawaii Department of Human Services (DHS)/Med-QUEST Division (MQD) requires all care providers who serve QUEST members to register with the new MQD provider enrollment system, HOKU, by December 31, 2023. Learn more.
10.05.2023 - An updated Hawaii Care Provider Manual is now available.
Thank you for your interest in becoming a network care provider with UnitedHealthcare Community Plan of Hawaii. In joining our network, you’ll become part of a group of physicians, health care professionals and facilities who share our commitment to helping people live healthier lives and making the health care system better for everyone.
To join our network:
1. Submit your credentialing application
Credentialing is required for all licensed independent practitioners and facilities to participate in the UnitedHealthcare network. We partner with MDX and Optum to help manage the credentialing process. Please follow these steps to submit your credentialing application based on your practicing specialty. These are also the resources to call if you have a question or want to check the status of your application.
General Care Providers (excluding specialties listed below): Most care providers will work with MDX Hawaii, Inc. to begin the application process. You can reach MDX at 808-532-6989, option 2 from 8 a.m. to 5 p.m. Hawaii Time, Monday through Friday.
Mental Health or Substance Abuse Practitioners: If you work in this specialty area, you’ll contact Optum Behavioral Health Solutions, which handles credentialing and contracting on behalf of UnitedHealthcare. To get started, go to providerexpress.com (look under “Our Network” for specific instructions) or call 800-817-4705.
If you also provide medical services in addition to mental health and substance abuse services, you’ll work with MDX for credentialing. Please follow the instructions noted above.
Dental: If you work in this specialty, you’ll contact Dental Benefit Partners to begin the credentialing process. To get started, visit https://www.uhcdental.com/ (look under “Join Our Network”) or call 800-822-5353.
2. Complete your participation agreement
After credentialing is complete, UnitedHealthcare Community Plan will send you a Participation Agreement (contract) through a secure application called DocuSign. (If we don’t have a valid email address for you, we’ll mail you the Participation Agreement.) Once contracting is completed, you’ll receive the countersigned agreement with your effective date.
If you’re joining a medical group that already has a participation agreement, you’ll be added to the group agreement once credentialing has been approved. A new contract will not be issued.
3. Get connected with us electronically
Once you are credentialed and have received your countersigned agreement, your next step is to know how to get connected with us electronically so you can take advantage of our online tools, paperless options, electronic payments and more. Review our Quick Start Guide for the most recent checklist.
We’re here to help! If you have questions, please call us at 888-980-8728 from 7:45 a.m. to 4:30 p.m. Hawaii Time, Monday through Friday.
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/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
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.
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.
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.