Welcome to the Home for Care Provider Resources

For UnitedHealthcare Community Plan of Maryland

Welcome

For UnitedHealthcare Community Plan of Maryland

Welcome to the Home for Care Provider Resources

For UnitedHealthcare Community Plan of Maryland

Welcome

For UnitedHealthcare Community Plan of Maryland

UnitedHealthcare Community Plan of Maryland 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 menu 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

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Hours of Operation: 8:00 am - 6:00 pm EST
Provider Call Center: 877-842-3210
Member Services Number: 800-318-8821 (TTY 711),  Monday-Friday, 8:00 am to 7:00 pm EST

Mailing Address:
UnitedHealthcare Community Plan
10175 Little Patuxent Parkway
Columbia, MD 21044

Claims Mailing Address:
UnitedHealthcare Community Plan
PO Box 31365
Salt Lake City, UT 84131 

Utilization Denial & Appeals Department Mailing Address:
UM Denial & Appeals Department
PO Box 31365
Salt Lake City, UT 84131

Claims Appeals Mailing Address:
UnitedHealthcare Community Plan Appeals-Maryland
PO Box 31365
Salt Lake City, UT 84131

Credentialing Updates: 
Contact the National Credentialing Center at 1-877-842-3210.

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.

Visit UHCCommunityPlan.com/MD for current member plan information including provider directories, dental plans, vision plans and more.

Plan information is available for:

  • Maryland HealthChoice

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

Referrals are required for most specialty services.

The links below provide more information on our referral requirements including how to submit online referrals.

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, 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.

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

Last Modified | 09.27.2022

The Maryland Department of Health Monkeypox Vaccination Pre-Registration System is now available.

Learn More

Last Modified | 09.12.2022

UnitedHealthcare Community Plan of Maryland providers must submit appeals and grievances through the proper channels.

Learn More

Last Modified | 07.29.2022

Maryland UnitedHealthcare Community Plan members with asthma may receive additional support for their medications. Health care professionals can receive a unique list for scheduling follow-up appointments.

Learn More

Last Modified | 07.21.2022

On Jan. 13, 2022, Maryland Medicaid expanded coverage for evidence-based home visiting services (HVS) for all Medicaid participants.

Learn More

Last Modified | 05.16.2022

Health care professionals who wish to contract with UnitedHealthcare Community Plan may need a site visit as part of the credentialing process.

Learn More
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UHC On Air gives you in-depth program information and meaningful updates from UnitedHealthcare 24/7and from any device.
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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. 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.