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For UnitedHealthcare Community Plan of Hawaii


For UnitedHealthcare Community Plan of Hawaii

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UnitedHealthcare Community Plan of Hawaii Homepage

Prior Authorization and Notification Resources

Current Policies and Clinical Guidelines

Provider Administrative Manual and Guides

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 Community Plan 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

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

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.
  • Home and Community-Based Services: Please email UnitedHealthcare Community Plan at hcbs_ltccontracting@uhc.com or call 888-980-8728. 
  • Dental: If you work in this specialty, you’ll contact Dental Benefit Partners to begin the credentialing process. To get started, visit dbp.optum.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.


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/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.

Review our Quick Start Guide to learn how to get connected to our online tools and resources before seeing your first UnitedHealthcare member.

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

3rd Quarter 2020 Preferred Drug List Updates- UnitedHealthcare Community Plans

Last Modified | 06.15.2020

UnitedHealthcare Community Plan’s Preferred Drug List (PDL) is updated quarterly by our Pharmacy and Therapeutics Committee. Please review the changes and update your references as necessary. The plan is for AZ, CA, HI, MD, NE, NV, NJ, NY, NY EPP, OH, PA CHIP, RI and VA.

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
DUR Educational Newsletter: Safety in Respiratory Therapy - UnitedHealthcare Community Plan

Last Modified | 04.24.2020

The National Asthma Education and Prevention Program (NAEPP) published guidelines for the treatment of asthma in2007.¹ The guidelines outline goals of therapy that include the prevention of recurrent exacerbation and need for emergency department or hospital care, the prevention of reduced lung growth in children or loss of lung function in adults, and the optimization of pharmacotherapy with minimal or no adverse effects.

Learn More
Update: Nonphysician Health Care Professionals Billing Evaluation and Management Codes Policy, Professional - Effective March 31, 2020 - UnitedHealthcare Community Plan of FL, HI, MD, MI, OH, PA, VA

Last Modified | 03.02.2020

Effective with dates of process on or after March 31, 2020 in alignment with and CPT ®, reimbursement for Evaluation and Management (E/M) codes (99201-99499) submitted by an audiologist will be denied.

Learn More
Update: Laboratory Services Policy, Professional - Effective May 18, 2020 UnitedHealthcare Community Plan of AZ, CA, FL, HI, KS, MD, MA, MS, MO, NE, NJ, NY, PA, RI, TN, TX, VA, WA, WI

Last Modified | 03.02.2020

Laboratory Services Policy, Professional - Effective May 18, 2020 UnitedHealthcare Community Plan of AZ, CA, FL, HI, KS, MD, MA, MS, MO, NE, NJ, NY, PA, RI, TN, TX, VA, WA, WI

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.


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.