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.

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. 

View the Are You Storm Ready? preparation and tips flyer.

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.

Important Information from UnitedHealthcare on COVID-19

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.

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 Benefits 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

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

• Louisiana Crisis Response System Fact Sheet
• Louisiana Crisis Response Region 1 Fact Sheet 
• Louisiana Crisis Response Region 2 Fact Sheet 
• Louisiana Crisis Response Region 3 Fact Sheet 
• Louisiana Crisis Response Region 7 Fact Sheet 
• Louisiana Crisis Response Region 10 Fact Sheet

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.

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 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.