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For UnitedHealthcare Community Plan of Iowa

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For UnitedHealthcare Community Plan of Iowa

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UnitedHealthcare Community Plan of Iowa 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.

Provider Call Center

1-888-650-3462, available from 7:30 a.m.-6:00 p.m. Central Time (CST).

Contact us for information regarding:

  • Behavioral Health referral
  • Claims corrections
  • Getting a member a ride
  • Language interpreter services
  • Member eligibility
  • Prior authorization
  • Reach a community-based case manager
  • Referrals to specialists

Mailing Address

UnitedHealthcare Community Plan
1089 Jordan Creek Parkway, Suite 320
West Des Moines, IA 50266

Claims and Appeals

Claims Mailing Address

UnitedHealthcare
Attn: Claims
P.O. Box 5220
Kingston, NY 12402-5220

Claims Appeals and Disputes

UnitedHealthcare Community Plan
P.O. Box 31364
Salt Lake City, UT 84131

Pharmacy Contact Information

Prior Authorizations Phone: 800-310-6826
Prior Authorizations Fax: 866-940-7328

For Credentialing and Attestation updates, contact the National Credentialing Center at 1-877-842-3210.

If you’re a Home- and Community-Based Service (HCBS) provider, please contact hcbs_iacred@uhc.com.

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

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.

Helpful Resources

Visit UHCCommunityPlan.com/IA 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:

  • Iowa UnitedHealthcare Community Plan - Iowa Health Link
  • Iowa UnitedHealthcare Community Plan - Iowa hawk-i

Member dental plan and benefit information can be found at UHCCommunityPlan.com/IA and myuhc.com.

Provider Advocate Information

Clinical Practice Consultant Information

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.

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

Enteral Tubing Reimbursement Policy Notification

Last Modified | 11.02.2018

We're making a change on Dec. 1, 2018, to allign our reimbursement policy with Iowa Medicaid Enterprise's (IME) clinical policy for Healthcare Common Procedure Coding System (HCPS) code B99998 Not Otherwise Classified (NOC) for enteral supplies. We previously followed the Centers for Medicare & Medicaid Services reimbursement policy for these supplies.

Learn More
Obstetrical Ultrasound Reimbursement Policy Update: Quantity Limitations - Beginning Dec. 1, 2018 - UnitedHealthcare Community Plan of Iowa

Last Modified | 10.25.2018

Starting Dec. 1, 2018, UnitedHealthcare Community Plan will change the existing Obstetrical Ultrasound Policy to further align with Medicaid guidelines.

Learn More
Notification to Integrated Health Homes and Habilitation Care Providers: Prior Authorization of Habilitation Services Effective Nov. 1, 2018

Last Modified | 10.15.2018

Effective for dates of services (DOS) on and after November 1, 2018, UnitedHealthcare Community Plan will implement a new prior authorization requirement for home-based habilitation services. This bulletin provides you with specific information regarding these new requirements, as well as timing for this change.

Learn More
Reprocessing Notification for Outpatient Hospital Rebase Claims for UnitedHealthcare Community Plan of Iowa

Last Modified | 10.12.2018

Reprocessing Notification for Outpatient Hospital Rebase Claims for UnitedHealthcare Community Plan of Iowa

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Rate Floor Reimbursement Expiration Reminder for UnitedHealthcare Community Plan of Iowa

Last Modified | 08.22.2018

The rate floors for reimbursement for all Iowa Medicaid providers have expired. The Iowa Department of Human Services (DHS) established rate floor reimbursement to provide stability for providers and members when Medicaid transitioned from fee-for-service to managed care under IA Health Link in April 2016.

Learn More
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Logos: ia health link, hawk-i and NCQA seal

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.