Welcome to the Home for Care Provider Resources

For UnitedHealthcare Community Plan of Kentucky

Welcome

For UnitedHealthcare Community Plan of Kentucky

UnitedHealthcare Community Plan of Kentucky 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

Provider Services: ky_provider_requests@uhc.com

This email inbox is intended to be used solely for communications that do not contain unencrypted Protected Health Information (PHI). Email messages and any documents containing PHI are protected by various state and federal laws including 45 C.F.R. Part  164. No emails or documentation should be sent to this inbox that contain PHI unless the communication is encrypted. Examples of PHI include a member’s name, date of birth, any detail regarding their medical condition including diagnoses and any other combination of identifiable information.

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

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 Manuals.  

Learn about requirements for joining our network

If you have questions about KHIE or want to begin the connection process, please email us at KHIE@ky.gov, call us at 502-564-7992 EXT 2800 or find us online https://khie.ky.gov/Pages/index.aspx.

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.

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

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.  

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.

Current News, Bulletins and Alerts

October 2018 Network Bulletin

Last Modified | 10.22.2020

In the October Network Bulletin, you can read about our new data exchange and medical record collection programs, updates to notification/prior authorization requirements for specialty medical injectable drugs, expansion of the Dual Special Needs program, and much more.

Learn More
Medical Policy Documentation Requirement Updates Frequently Asked Questions - UnitedHealthcare Community Plans

Last Modified | 10.20.2020

We’ve refined medical policy documentation requirements and enhanced clinical coverage criteria for various procedures. This document contains information on effective dates by state and frequently asked questions.

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Summary of COVID-19 Dates by Program

Last Modified | 10.12.2020

This document is intended to be a quick reference guide for the beginning and end dates of program, process or procedure changes that UnitedHealthcare has implemented as a result of COVID-19.

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10/01/2020 - UnitedHealthcare Specialty Medical Injectable Drug Program Update Bulletin: October 2020

Last Modified | 10.15.2020

Monthly UnitedHealthcare specialty medical injectable drug program updates

Learn More
10/01/2020 – UnitedHealthcare Commercial Medical Policy Update Bulletin: October 2020

Last Modified | 10.01.2020

This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Commercial Medical Policies, Medical Benefit Drug Policies, Coverage Determination Guidelines (CDG), and/or Utilization Review Guidelines (URG).

Learn More
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Accredited NCQA Health Plan Accredited NCQA Health Plan

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.