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.
For BH Auth Inquiries: 877-440-9946
Provider Services Call Center
Provider Relations
Network Management Resource Team
Technical Support:
Behavioral Health Services
Housing Stabilization Navigator is Camille Edosa:
Pharmacy Services:
UnitedHealthcare Dental:
MARCH Vision Care:
MTM for Nonemergency Medical Transportation Services
For Credentialing and Attestation updates, contact the National Credentialing Center at 1-877-842-3210.
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:
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:
After you submitted your first paper claim and your validation is completed, you may submit claims using our portal.
Electronic payment solution: Optum Pay™
UnitedHealthcare Community Plan has launched the replacement of paper checks with electronic payments and will no longer be sending paper checks for health care professional payment. You will have the option of signing up for Automated Clearing House (ACH)/ direct deposit, our preferred method of payment, or to receive a Virtual Card payment (Virtual Card). The only alternative to a Virtual Card is direct deposit. Both options allow you to get paid quickly and securely. For more information on how to enroll visit Electronic Payment Solutions.
Housing Stabilization Services (HSS) is a Medical Assistance benefit to help people with disabilities and seniors find and keep housing. Housing stabilization services are a state plan (not waiver) Home and Community-Based Services (HCBS).
Eligibility as a Housing Stabilization Services provider:
Before rendering services to UnitedHealthcare Community Plan members, you’ll need to enroll or be already registered as a Housing Stabilization Services (HSS) provider with the Department of Human Services Minnesota Health Care Programs (DHS MHCP). For enrollment information visit Minnesota Provider Screening and Enrollment (MPSE) portal.
Member Eligibility for Housing Stabilization Services:
To identify if a member is eligible for the HSS benefits refer to Housing Stabilization Services.
Billing Housing Stabilization Services:
Once you are registered with DHS MHCP as an HSS provider, your claims will be eligible for reimbursement. Please note you don’t need a UnitedHealthcare Community Plan contract to provide HSS services and submit claims. Housing stabilization services agencies must follow general DHS MHCP billing policies and guidelines Housing Stabilization Services (state.mn.us). Claims for HSS are considered fee for service, with the rates and diagnoses established by DHS MHCP.
Provider Validation:
Because HSS 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, HSS 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:
After you submitted your first paper claim and your validation is completed, you may submit claims using our portal.
Electronic payment solution: Optum Pay™
UnitedHealthcare Community Plan has launched the replacement of paper checks with electronic payments and will no longer be sending paper checks for health care professional payment. You will have the option of signing up for Automated Clearing House (ACH)/ direct deposit, our preferred method of payment, or to receive a Virtual Card payment (Virtual Card). The only alternative to a Virtual Card is direct deposit. Both options allow you to get paid quickly and securely. For more information on how to enroll visit https://www.uhcprovider.com/en/claims-payments-billing/Electronic-Payment-Solutions.html.
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 are found in the UnitedHealthcare Community Plan Care Provider Manuals.
Overview
The Centers for Medicare & Medicaid Services (CMS) established the Medicaid Managed Care Rule to:
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.
Minnesota Senior Care Plus (MSC+) and Minnesota Senior Health Options (MSHO): Open network access for HCBS services
MSC+ and MSHO Plan members in Minnesota who are eligible to receive long-term services and supports (LTSS) may use the Minnesota Department of Human Services (DHS)-enrolled open access network for the following home and community-based services (HCBS):
A list of these providers is included in the https://mhcpproviderdirectory.dhs.state.mn.us/. You can also access a complete list through the DHS MinnestotaHelp website.
Questions?
Call Provider Services: 877-440-9946
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:
For help using CommunityCare, please see our Quick Reference Guide. If you’re not familiar with our portal, go to UHCprovider.com/portal.
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.
Restricted Recipient Program (RRP) Contact Information
Phone 888-413-0945
Email: MN_RRP@uhc.com
Fax: 855-369-7560
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.
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.
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.