UnitedHealthcare Community Plan of Louisiana 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.
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If you file claims with Louisiana Medicaid, you must enroll in the new Medicaid Provider Enrollment Portal to continue being reimbursed. In fall 2021, Louisiana Medicaid mailed letters to providers about this enrollment requirement.
To simplify the process, UnitedHealthcare Community Plan of Louisiana has partnered with Louisiana Medicaid for a provider enrollment drive that will devote time to each provider type over the next few months. During this time, we will be sharing resources, training, and answers to commonly asked question. Our goal is to have each provider enroll during their designated provider week, if not sooner.
If you have any questions or concerns, you can reach out to Louisiana Medicaid.
- Web site: www.ldh.la.gov/medicaidproviderenrollment
- Email: LouisianaProvEnroll@gainwelltechnologies.com
- Phone: #1-833-641-2140 (Monday – Friday, between 8 a.m. and 5 p.m. CST)
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.
We also have a dedicated team of Community Provider Advocates available statewide to support provider needs.
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
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.
Thank you for your interest in becoming a network care provider with UnitedHealthcare Community Plan of Louisiana. In joining our network, you’ll become part of a group of physicians, health care professionals and facilities who share our commitment to helping people live healthier lives and making the health care system better for everyone.
To get started, follow the steps to join our network. You may refer to the state-specific credentialing requirements for Louisiana Community plan in the UnitedHealthcare Community Plan Care Provider Administrative Guide.
UnitedHealthcare adheres to the Louisiana Revised Statute 22:1874 (which incorporates Act 897) for practitioners joining an existing, contracted medical group to be temporarily approved to receive claims payment upon submitting their completed UnitedHealthcare application, and then will be fully credentialed upon application approval.
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.
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.
Dental Benefits for Enrollees under Age 21
Dental Benefits for enrollees under the age of 21 may be managed by DentaQuest or Managed Care of North America (MCNA). Both providers are premier dental benefits administrators that provide 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:
- MCNA: 1-855-701-6262.
- DentaQuest: 1-855-229-6848
Dental Benefits for Enrollees over Age 21
UnitedHealthcare Community Plan provides dental benefits for enrollees over 21 through value added benefits. Enrollees over age 21 get up to $500 per year for routine dental exams, x-rays and cleanings. For benefits, claims, provider enrollment, direct deposit issues, demographic changes, NPI Information, etc., contact:
- UnitedHealthcare Community Plan: 1-866-675-1607
Vision Benefits
Enrollees vision plan and benefit information can be found at UHCCommunityPlan.com/LA and myuhc.com.
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
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
For all other vision services please contact UnitedHealthcare Community Plan customer service at 1-866-675-1607.
Vision Benefits for Enrollees under Age 21
- One comprehensive eye exam every 12 months; and
- Up to 3 pairs of frames every 12 months; and
- 2 units of lenses of every 12 months
Vision Benefits for Enrollees over Age 21
- One comprehensive eye exam every year 12 months; and
- One pair of frames every 12 months
- $100 allowance for frames/lenses every year 12 months
- One 12 month supply of contacts
- $105 allowance for contacts
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.
The Louisiana Department of Health (LDH)/Office of Behavioral Health (OBH) is in the process of expanding upon and restructuring the Medicaid service delivery system related to crisis services.
Crisis Response Phone Number: 1-866-232-1626
The best way for primary care providers (PCPs) to view and export the full member roster is using the CommunityCare tool, 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 our portal, go to UHCprovider.com/portal.
Member Primary Care Physician Reassignment
Check out Care Conductor in the UnitedHealthcare Provider Portal under Clinical & Pharmacy.
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.
Email us at ethics-integrity_office@uhc.com, 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 2023 Contract and Amendments of the Healthy Louisiana contract is available on the Louisiana Department of Health website.
View the UnitedHealthcare Community Plan 2023 Contract and Amendments for Healthy Louisiana
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.
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.
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.