Provider Service Center

1-866-675-1607

Your "one call" resource line. Contact 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

If your office relocates or closes for an extended period, please contact us at 1-877-369-1302.

Claims and Appeals

Claims Mailing Address

UnitedHealthcare Community Plan
PO Box 31341
Salt Lake City, UT 84131-0341

Claims Appeals Address

UnitedHealthcare Community Plan
Attn: Claims Administrative Appeals
PO Box 31364
Salt Lake City, UT 84131-0364

Utilization Management Appeals Address

UnitedHealthcare Community Plan
Attn: Claims Administrative Appeals
PO Box 31364
Salt Lake City, UT 84131-0364

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

Are your patients prepared for hurricane season?

We want to help make sure your patients are prepared for hurricane season and the resulting hazards such as storm surge, high winds, tornadoes, and flooding. 

Tips from Louisiana Governor's Office and the American Red Cross

• Update Contact Information: Encourage your patients to regularly update their address and phone contact information, so they can be reached in case of an emergency. 
  • Members can contact UnitedHealthcare Community Plan Member Services at 1-866-675-1607 (TTY: 711) or contact the NurseLine at 1-877-440-9409.
• Assemble an Emergency Preparedness Kit:  Put an emergency kit together and include your UnitedHealthcare Community Plan and Medicaid ID cards. 
  • Kits should include: non-perishable food, water, extra cash, first aid supplies, a flashlight, batteries, a radio, a multi-purpose tool, medications and medical items, copies of personal documents, ID cards, cell phone with chargers, map of the area, an emergency blanket, emergency numbers, sanitation supplies, and other essential items. 
  • Think about the special needs of family members and pets and include items such as baby supplies or pet food. 
• Prepare and Plan for an Evacuation: Before an emergency happens, think about where to go if you are told to evacuate. Make sure you have a couple of places that you can go, such as a friend's home in another town, a motel or a shelter. 
  • Make sure to have the phone numbers of family and friends with you. It's helpful to have these numbers written down in case you don't have power for your mobile phone or you need to use a landline to make phone calls.
  • Make sure to have a paper map because you may need to take unfamiliar routes if major roads are closed or clogged. 
  • Develop a plan on how you will communicate with family and friends in an emergency. Agree on and share your evacuation routes so everyone knows where to go and what to do.
• Stay Informed: Listen to NOAA weather radio, local radio stations or TV stations for evacuation instructions. 
  • If you are told to evacuate, do so immediately. 

You can find more information at the Louisiana Department of Health's Louisiana Volunteers in Action (LAVA).

In case of a hurricane or other disaster, your patients can register on the American Red Cross Safe and Well website to let family and friends know about their welfare. Those without Internet access can call 1-866-GET-INFO.

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. 

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.

Helpful Resources

• Medicaid Managed Care Rule Overview Presentation
• Medicaid Managed Care Rule FAQs

UnitedHealthcare Community Plan maintains a grievance system for members that ensures receipt and prompt resolution of informal and formal member grievances and access to the state fair hearing process.

Filing a Member Grievance

A member, a representative of the member's choice, or a CCN-S provider, acting on behalf of the member with the member's written consent, may file a grievance with UnitedHealthcare Community Plan.

Grievances may be filed orally by calling the toll-free number for our Member Services Call Center 1-866-675-1607 or in writing by mailing the grievance to our Regional Mail Operations (RMO) at:

UnitedHealthcare
P.O. Box 31364
Salt Lake City, UT 84131-0364

We route telephonic/verbal grievances through our technology that identifies call type and routes to other databases according to category. When the system identifies the call as a grievance, the information is logged into the system, and forwarded to a triage team who puts the information into our tracking system where a case file is created and populated.

On receipt of a written grievance, appropriate personnel scan them into the tracking system and create a case file.

Per our Member Grievance Policy, and on initial contact, we log and track criteria including member.

Visit UHCCommunityPlan.com/LA for current member plan information including sample member ID cards, provider directories, dental plans, vision plans and more.

Plan information is available for:

• UnitedHealthcare Community Plan - Healthy Louisiana Plan

Member plan and benefit information can also be found at UHCCommunityPlan.com/LA and myuhc.com.

Dental Benefits

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

Adult Dental Benefits

Members over 21 will be provided routine dental exams, x-rays, cleanings, fillings and extractions with in-network providers limited to $500 per year. Members should call Customer Service at 1-866-675-1607.

Dental Benefts for Members under Age 21

Managed Care of North America is a premier dental benefits administrator that provides exceptional service to State Agencies and managed care organizations for Medicaid. For benefits, claims, provider enrollment, direct deposit issues, demographic changes, NPI Information, etc., contact Managed Care of North America Customer Service at 1-855-701-6262.

Vision Benefits

Member vision plan and benefit information can be found at UHCCommunityPlan.com/LA and myuhc.com.

For Members under 21 Years of Age

March Vision Care is the vision vendor for UnitedHealthcare and provides routine vision services which include:

• Services and exams for vision correction and refraction error
  
• Eyewear, contacts if the only means to restore vision

For all other vision services please contact UnitedHealthcare Community Plan customer service at 1-866-675-1607.

For Members over Age 21

March Vision Care is the vision vendor for UnitedHealthcare and provides routine vision services. Additional vision and services will be provided to complement the limited Medicaid vision benefit. Services include:

• One Routine Eye Exam every two years; and 
• $100 allowance for frames/lenses every two years
  

Note: Vision services performed by an Optometrist are reimbursable for routine and non-routine services. Claims must be submitted to March Vision Care for processing. This is due to the expanded scope of the services the Louisiana Board of Optometry now allows Optometrists to perform in the office setting. 

March Vision Care Contact Information

Phone:  1-844-52-MARCH or 1-844-526-2724
Online:  marchvisioncare.com/providerreferenceguides.aspx
Mailing Address for Claims:

Claims Processing Center
6701 Center Drive West, Suite 790
Los Angeles, CA 90045

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. 

Regular and Non-Urgent Third Party Liability Update Requests - Effective Sept. 1, 2016

Regular and non-urgent Third Party Liability update requests must be sent directly to HMS via one of the methods below:

Fax: 1-877-204-1325  
Email: latpr@hms.com 
Phone: 1-877-204-1324

Traditional Medicare Updates

Traditional Medicare updates should still be sent to Louisiana Department of Health at 1-225-342-1376.

Urgent Updates

All Urgent updates, where a member may be in danger of not receiving services (such as prescription refills), should still be sent to the selected Healthy Louisiana Plan.

UnitedHealthcare Community Plan 
Customer Service Line: 1-866-675-1607
Email: PI_COB_research@uhc.com

For more detailed information about the Private Third Party Liability process, please read the Louisiana Department of Health Bulletin Notice (Informational Bulletin 16-15).

The latest version/s of the United Healthcare Community Plan 2015 Contract and Amendments of the Healthy Louisiana contract is available on the Louisiana Department of Health website.

View the UnitedHealthcare Community Plan 2015 Contract and Amendments.