Welcome to the Home for Care Provider Resources

For UnitedHealthcare Community Plan of Indiana

Welcome

For UnitedHealthcare Community Plan of Indiana

Welcome to the Home for Care Provider Resources

For UnitedHealthcare Community Plan of Indiana

Welcome

For UnitedHealthcare Community Plan of Indiana

UnitedHealthcare Community Plan of Indiana 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

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UHC Provider Services (Claims, Prior Authorization and Eligibility Questions)

877-610-9785
Available 8 a.m. – 8 p.m. Eastern Time, Monday through Friday

Prior Authorization
877-610-9785
Fax: 844-897-6514

Member Services
800-832-4643, TTY 711 for help accessing member account
Available 8 a.m. – 8 p.m. Eastern Time, Monday through Friday

Multilingual/Telecommunication Device for the Deaf (TDD) Services
800-832-4643 (members)
877-610-9785 (providers)
TDD 711
Available 8 a.m. – 8 p.m. Eastern Time, Monday through Friday, except state-designated holidays

Nurseline
800-832-4643
Available anytime

Optum Behavioral Health
800-888-2998 (toll-free)
Fax 844-897-6514
providerexpress.com

Dental Services
www.uhcdental.com
844-402-9118

MARCH Vision Care
www.marchvisioncare.com
844-486-2724

Vision Providers: Learn more about becoming a vision provider for Indiana Community Plan members at Join Our MARCH Network

Transportation Services (Arrange Non-emergent transportation 48 hours in advance)
Member Services: 800-832-4643

Pharmacy Services (OptumRX)
866-215-5046

Pharmacy Prior Authorization/Notification

800-310-6826

 

Medical Provider Advocates by Counties Served (For Medical Providers)

Jesslyn Lamar, Provider Advocate
Jesslyn_M_lamar@uhc.com
(952) 202-7189
Counties Served: Lake, Porter and LaPorte

Lori Reeder, Provider Advocate
Lreeder@uhc.com
(763) 321-3822
Counties Served: St. Joseph, Elkhart, LaGrange, Steuben, DeKalb, Noble, Kosciusko, Marshall, Starke, Jasper, Newton, Benton, White, Pulaski, Fulton, Cass, Carroll, Howard, Miami, Wabash, Whitley, Allen, Huntington, Grant, Wells, Adams and Blackford

Zakiya Cooper, Provider Advocate
Zakiya_Cooper@uhc.com
(612) 383-4914
Counties Served: Warren, Tippecanoe, Clinton, Tipton, Madison, Delaware, Jay, Randolph, Henry, Hancock, Marion, Hamilton, Boone, Montgomery, Fountain, Vermillion, Parke, Putnam, Hendricks, Wayne, Union, Fayette, Rush, Shelby, Johnson, Morgan, Owen, Vigo, Franklin, Decatur, Bartholomew, Brown, Monroe and Clay

Karen Cockerham, Provider Advocate
Karen.Cockerham@uhc.com
(618) 943-6693
Counties Served: Sullivan, Greene, Lawrence, Jackson, Jennings, Ripley, Switzerland, Jefferson, Scott, Washington, Orange, Martin, Daviess, Knox, Gibson, Pike, Dubois, Crawford, Posey, Vanderburgh, Warrick, Spencer, Perry, Harrison, Floyd and Clark

Christopher Turner, Provider Advocate
Chris_W_Turner@uhc.com
(763) 957-6842
Counties Served: Dearborn and Ohio

Jen Smith, Director of Provider Market Operations
SmithJen@uhc.com
(952) 406-6498

Behavioral Health Provider Advocates (For Behavioral Health Providers) - Statewide

David Hoover, Senior Provider Relations Advocate
David_Hoover@optum.com
(763) 330-7588

Belen Stewart, Provider Relations Advocate
Belen.Stewart@optum.com
(612) 632-5962

David Lauter, Director of Provider Relations
David.Lauter@optum.com
(314) 592-3740

Vision Provider Advocates (For Vision Providers) - Statewide

Keisha Brown, Provider Advocate
Keisha_Brown@uhc.com
(952) 202-8696

Cassandra Pattison, Provider Advocate
Cassandra_Pattison@uhc.com
(210) 474-5592

Dental Provider Advocates (For Dental Providers) - Statewide

Paul Curry, Provider Advocate
Paul_Curry@uhc.com
(952) 202-2072

Catrice Campbell, Provider Advocate
Catrice_Campbell@uhc.com
(763) 283-4522

Nursing Facility Provider Advocates (For Nursing Facility Providers) - Statewide

Stephen Price, Provider Engagement Manager 
Stephen.A.Price@optum.com
(612) 474-7315

Kelly Vorpahl, Provider Advocate
Kelly_Vorpahl@optum.com
(612) 474-6318 

Tiffany Cashion, Provider Advocate
Tiffany.Cashion@optum.com
(317) 352-6578

Thank you for your interest in joining the network for the UnitedHealthcare Community Plan of Indiana Hoosier Care Connect. In joining our network, you’ll become part of a group of health care professionals and facilities who share our commitment to helping Indiana Hoosier Care Connect members live healthier lives and making the health care system better for everyone.

There are three key phases to joining the network:

  1. Credentialing: The process of reviewing the qualifications and appropriateness of a provider to join the health plan’s network. Credentialing requirements and processes will follow all National Committee for Quality Assurance (NCQA) guidelines.
  2. Contracting/Negotiating: The process of the provider and managed care entity (MCE) formally executing an agreement that outlines reimbursement rates, scope of services, etc. for the provider to deliver medical services. 
  3. Enrollment: The process of loading a contracted and credentialed provider to all MCE internal systems, loading for claims payment and loading to the provider directory (if applicable).

Please review the detailed requirements and instructions, as they do differ based on your medical specialty.

Network participation effective date

UnitedHealthcare has adopted the Indiana Health Coverage Programs (IHCP) health care professional effective date policy as of Jan. 1, 2022. Under this policy, the effective date for all health care professionals and facilities will be the 1st of the month following our receipt of a complete network participation request, regardless of the contract execution date or credentialing completion date. The IHCP’s Network Effective Date Policy does not apply to providers who have a delegation agreement in place with UnitedHealthcare.

  • The network participation receipt date is the date UnitedHealthcare receives your complete network participation request electronically via an online portal or email (if applicable). To be considered complete, all required fields must be completed and all required supporting documentation must be provided.
    • The UnitedHealthcare network effective date must be after the IHCP effective date, as required by the state of Indiana. If you are not enrolled and effective with IHCP prior to submitting a complete participation request to UnitedHealthcare, your effective date will be adjusted to match your ICHP effective date.
  • This applies whether you are being added to an existing contract or if you are a brand-new professional who is not part of an existing contract.
  • In most cases, the effective date will be retroactive back to the first of the month following receipt of the complete network participation request. Health care professionals will not be fully effective until they are credentialed and have a signed contract or contract amendment.
    • If a health care professional is unable to be credentialed, they will not be accepted into our network.
    • If a health care professional and UnitedHealthcare cannot come to terms with a contract, they will not be accepted into our network.

Please note:

  • To be able to render services as a network health care professional, the contract or contract amendment must still be executed by both parties.
  • If services were rendered prior to the effective date, these services may be considered out of network and require authorization.
  • Health care professionals should hold all claims until they receive a welcome letter from UnitedHealthcare that confirms they are effective with the network.
    • UnitedHealthcare and health care professionals are expected to complete all pieces of the network participation process in a timely manner. However, in instances where the network participation process extends for a period longer than the standard timeframe, UnitedHealthcare will not hold health care professionals to the timely filing limit for claims rendered before the network effective date.
  • UnitedHealthcare is currently an open network according to Indiana Office of Medical Policy and Planning (OMPP) requirements. Currently, we do not require an out-of-network authorization for health care professionals to see Hoosier Care Connect members.
  • The IHCP Provider Enrollment webpage has more information about Indiana Hoosier Care Connect network enrollment and credentialing with IHCP managed care entities.

Questions?

If you have questions about our process or need assistance, please email networkhelp@uhc.com. Include the health care professional’s full name, National Provider Identifier (NPI), Tax Identification Number (TIN) and brief description of the request. If you would like to speak to someone directly, please note that in the email. A UnitedHealthcare representative will respond to your request.

You may also call Provider Services for UnitedHealthcare Community Plan of Indiana at 877-610-9785, Monday–Friday, 8 a.m. to 8 p.m. ET.

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/IN for current member plan information including sample member ID cards, provider directories, value-added benefits, dental plans, vision plans and more for: 

  • UnitedHealthcare Community and State Hoosier Care Connect

Find a Care Provider:

UHC C&S member ID card for Hoosier Care Connect:

IN Hoosier Care Connect membership card front and back

Network Management

Have questions about your contract, demographics or fee schedule?
Email: IN_NM_Team@uhc.com
Please ensure your email includes:

  1. Physician or facility name
  2. Organization Tax ID Number
  3. Contact representative name & telephone number

Northwest Indiana Network Management-Managed by Illinois Network Management
Address: 200 E Randolph St, Ste 5300 Chicago, IL 60601
Phone: 1-312-803-5900
Fax Number: 1-888-311-4599

Indiana Network Management-Indianapolis and Fort Wayne
Address: 7440 Woodland Drive, Dept. 100 Indianapolis, IN 46278
Contract/Credentialing/Premium Designation Inquiries: Email networkhelp@uhc.com and include health care professional / facility name, contact name and phone number, NPI, TIN, and brief description of your inquiry including any reference numbers.
Demographic Changes: 1-877-842-3210

Network Management-Southeast & Southwest
Address: 7440 Woodland Drive, Dept. 100 Indianapolis, IN 46278
Contract/Credentialing/Premium Designation Inquiries: Email networkhelp@uhc.com and include health care professional / facility name, contact name and phone number, NPI, TIN, and brief description of your inquiry including any reference numbers.
Demographic Changes: 1-877-842-3210

Provider Relations

Physician and Facility Advocate Team
Have questions about claims challenges or educational opportunities?
Email:  Indiana_PR_Team@uhc.com

If you have a claim that remains unresolved after submission of a claim reconsideration, please ensure your email includes:

  1. Physician or facility name
  2. Organization Tax ID Number
  3. Contact representative name & telephone number
  4. Link ticket number (PTPCR # or CM #) or call reference number
  5. Member name
  6. Member ID
  7. Date of service
  8. Charge amount

CommunityCare

The best way for primary care providers (PCPs) to view and export the full member roster is using the CommunityCare feature on the UnitedHealthcare Provider Portal, 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 feature on the UnitedHealthcare Provider Portal, please see our Quick Reference Guide. If you’re not familiar with UnitedHealthcare Provider Portal, go to UHCprovider.com/portal.

CAHPS and the Health Outcomes Survey: The Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey and the Health Outcomes Survey (HOS) help provide feedback on your patients’ experience with you and with UnitedHealthcare. Learn more about CAHPS and HOS.

Care requirement standards

Office site quality

  • Clean and orderly overall appearance
  • Available handicapped parking
  • Handicapped accessible facility
  • Available adequate waiting room space
  • Adequate exam room(s) for providing member care
  • Privacy in exam room(s)
  • Clearly marked exits
  • Accessible fire extinguishers
  • Post file inspection record in the last year

Access to care requirements

Appointment

Accessibility standards

General care

Urgent/emergent care triage

24 hours/day

Initial appointment well child

Within 1 month of date calling to schedule an appointment

Routine physical exam

3 months

Initial appointment (non-pregnant adult)

3 months

Routine gynecological examination

3 months

New obstetrical patient

Within 1 month of date attempting to schedule an appointment

Non-urgent symptomatic

72 hours

Children with special health care needs

1 month

Specialty care

Emergency

24 hours

Urgent

48 hours

Non-urgent symptomatic

4 weeks

Prenatal care

First trimester

Within 14 days of request

Second trimester

Within 7 calendar days of
request

Third trimester

Within 3 business days of request or
immediately if an emergency

 High-risk

Within 3 business days of request or
immediately if an emergency

Postpartum exam

Between 3 and 8 weeks after delivery

Behavioral care

Outpatient behavioral health exams

Within 14 days of request

Routine/new patient exam

Within 10 days of request

Outpatient treatment

Within 7 days of discharge date

Post-psychiatric inpatient care

Within 7 days of discharge date

 

PATH: To help identify care opportunities, the UnitedHealthcare PATH program provides specific information for members who are due or overdue for specific services. The PATH Reference Guide outlines quality measurement program specifications and tools to address care opportunities, as well as how to report data and what billing codes to use.

Physician Performance-Based Compensation: This program includes the Patient Care Opportunity Reports (PCOR), the Patient-Centered Medical Home (PCMH) program, the Primary Care Physician Incentive (PCPi) program and Quality-Based Physician Incentive Program (QPIP). These provide actionable, patient-specific information to help you deliver the best possible clinical care and help you meet your personal and professional goals.

Questions?

For questions about quality programs for UnitedHealthcare Community Plan of Indiana, email or call the following representatives:

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.  

For more information on the Right Choices Program providers may call 877-610-9785. Providers can refer a member to the Right Choices Program by submitting the referral form via e-mail to in_rcp@uhc.com or by fax to 888-842-6007. 

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.

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NCQA Health Plan

Current News, Bulletins and Alerts

Last Modified | 05.16.2022

Health care professionals who wish to contract with UnitedHealthcare Community Plan may need a site visit as part of the credentialing process.

Learn More

Last Modified | 04.29.2022

Effective Aug. 1, 2022, Optum will manage prior authorization requests for non-oncology injectable medications that are covered on the medical benefit for UnitedHealthcare Community Plans.

Learn More

Last Modified | 04.25.2022

Effective June 1, 2022, we’re adding new codes to the prior authorization list for cardiovascular procedures, prostate procedures, spine surgery and cosmetic surgery procedures.

Learn More
View More News

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.

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.