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 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.
UnitedHealthcare Community Plan No Longer Affiliated with IA Health Link and Hawki Program; UnitedHealthcare Dual Complete® (HMO SNP) Not Affected
As of July 1, 2019, UnitedHealthcare Community Plan of Iowa will no longer provide Medicaid and Hawki coverage in Iowa; however, we’ll continue to serve our UnitedHealthcare Dual Complete (HMO SNP) members. We’re honored to have served Iowans in the IA Health Link program for the past three years and the Hawki program for the past twenty years.
Directing Your Patients
If patients have questions, please have them call their new managed care organization’s (MCO’s) Member Service’s phone number, which they’ll find on their ID card. If members have questions related to any services they received before July 1, 2019, they can call UnitedHealthcare Community Plan member services at 800-464-9484.
How this Affects UnitedHealthcare Dual Complete® (HMO SNP)
The UnitedHealthcare Dual Complete (HMO SNP) plan won’t be affected by this change. Eligible members can enroll in, and will be served by, the UnitedHealthcare Dual Complete (HMO SNP) plan, regardless of their MCO. UnitedHealthcare will still serve as their primary payer and members will continue to receive all the additional benefits of the plan. If members have questions about their UnitedHealthcare Dual Complete (HMO SNP) plan, they can call us at: 844-368-6883 (TTY 711),
8 a.m. – 8 p.m. in your time zone, 7 days a week.
If you have questions, please call Provider Services at 888-650-3462.
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.
The Clinical Practice Consultant program supports provider’s efforts to help members overcome barriers to health care. As part of this initiative, the dedicated Clinical Practice Consultant (CPC) will work with providers to help manage the clinical requirements involved with meeting Healthcare Effectiveness Data and Information Set (HEDIS) and other quality measures.
Manager of Case Manager Information
If the care provider is unable to contact a Community-Based Case Manager (CBCM) or has a situation that they are unable to resolve with the CBCM, please contact the Manager of Case Manager (MCM) for further assistance.
Please contact Provider Services at 888-650-3462 for inquiries related to your MCM.
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.
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.