The Minnesota Department of Human Services (MHCP) developed home and community-based services (HCBS) waivers to meet the needs of people who choose to receive services and support in their home or community, rather than in an institutional setting. The purpose of these programs is to promote community living and independence with services and support designed to address each person’s individual needs and choices.
Effective Jan. 1, 2023, UnitedHealthcare Community Plan (UHCCP) offers services to Minnesota Senior Care Plus (MSC+) and Minnesota Senior Health Options (MSHO) members on the Elderly Waiver (EW) for St. Louis County HCBS Waiver Services (state.mn.us).
With the exception of Elderly Waiver (EW), other waivers are managed by the Department of Human Services Minnesota Health Care Programs (DHS MHCP) and not the health plan. Members with CADI, BI, DD, CAC waivers need to contact the state and/or that waiver Case Manager in their county of residence. The HCBS Waiver services offered under UHC Community Plan's LTSS program can be found at HCBS Waiver Services (state.mn.us). United Healthcare does not offer the Alternative Care Program.
Member Eligibility for Home and Community Based Services:
To be eligible for EW, a person must choose and receive at least one home and community service in addition to case management through EW and:
- Be a Minnesota resident.
- Be age 65 or older.
- Be assessed by a long-term care consultation (LTCC) to need a nursing facility level of care.
- Be eligible for payment of long-term care under Medical Assistance.
- Have a community support plan that can reasonably ensure health and safety, within the individual budget established by the person's case mix classification.
- Pay a waiver obligation, if applicable.
Eligibility as a Home and Community Based Services provider:
All HCBS providers must comply with Medical Assistance (MA) and federally approved state service standards. All providers must work within their license, certification, or other requirements. Before rendering services to UHCCP members, you’ll need to enroll or be already registered as a HCBS provider with DHS. For enrollment information visit Home and Community-Based Services (HCBS) Programs Provider Enrollment (state.mn.us).
Service Authorization
HCBS providers do not need to contract with UnitedHealthcare; to begin your authorization process start by filling out the HCBS Provider Request Form and submit it by fax to 844-897-4552 or email at uhc_mn_ltss_cc@uhc.com.
HCBS for EW members must be initiated by the Care Coordinator who does an assessment and determines a need for HCBS services.
HCBS for non-EW members, must follow the authorization process by submitting the request form to the above fax or email. These requests are reviewed by the Health Plan.
DHS MHCP billing policies and guidelines
UHC follows DHS billing guidelines refer to HCBS Waiver Services - Billing for Waiver and Alternative Care (AC) Program (state.mn.us) and providers will be reimbursed according to the MHCP Fee Schedule.
Provider Validation:
Because HCBS providers don’t need to contract with UnitedHealthcare we require provider validation, to complete this step, please submit your first claim on paper using the CMS 1500 form, a sample of the form and instructions on how to fill it can be found at CMS 1500 Sample, and mail it along with a copy of your W9 to UnitedHealthcare Community Plan, P.O. Box 5270, Kingston, NY 12402-5270. Once UnitedHealthcare receives the paper claim, the Provider Validation team will create a provider record and process the claim; when you receive the Provider Remit Advice you will know your record has been created, please allow 30 days for this process. If you have questions you can reach to the Provider Validation Team at 844-368-5890, 8 a.m.-5 p.m. CT, Monday-Friday. We follow CMS National Uniform Claim Committee (NUCC) and National Uniform Billing Committee (NUBC) guidelines for HCFA 1500 and UB-04 forms.
Electronic claims submission:
After you submitted your first paper claim and your validation is completed, you may submit claims by electronic data interchange (EDI) using your Clearing House or through our UnitedHealthcare Provider Portal, for more information visit https://www.uhcprovider.com/en/resource-library/edi.html. Our payer ID is 87726.
Registering for the UnitedHealthcare Portal:
The UnitedHealthcare Provider Portal has more than 60 online tools — including claims submission, claims reconsideration, eligibility, prior authorization, referrals and more.
If you don’t have access to a Clearing House and after the initial paper claim has been processed, HCBS Providers can use our UnitedHealthcare Provider Portal. The first step is to create the One Healthcare ID and register for access to the UnitedHealthcare Provider Portal here. It is important to note that:
- A National Provider Identifier (NPI) number is not required to use the portal. If you do not have an NPI, enter all ‘0’ in this space.
- Provide your tax ID number (TIN)
- If you did not submit a copy of your W9 with your first paper claim, please upload it onto the online portal.
- Proof of servicing address (i.e., Utilities bill)
- Learn more about the portal and access training at UHCprovider.com/portal.
After you submitted your first paper claim and your validation is completed, you may submit claims using our portal.
Electronic payment solution: Optum Pay™
You will have the option of signing up for Automated Clearing House (ACH)/ direct deposit, our preferred method of payment, or to receive a paper check. To learn more please visit https://www.uhcprovider.com/en/claims-payments-billing/Electronic-Payment-Solutions.html.