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UnitedHealthcare Community Plan of Minnesota 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.

Plan changes


Effective December 31, 2024 the UHC Community Plan of Minnesota is exiting Minnesota Health Care Programs (Medical Assistance, MinnesotaCare, MSHO, MSC+ and SNBC). Members will be transferred to a new Managed Care Plan effective January 1, 2025. The Plan remains available to assist with dates of service when the member had active eligibility.

Please check eligibility before submitting requests. Connect with Provider Services through UHCprovider.com > Contact Us > Chat or call Provider Services for questions (877) 440-9946.

Prior Authorization and Notification Resources

For BH Auth Inquiries: 877-440-9946

Learn More

Current Policies and Clinical Guidelines

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Provider Administrative Manual and Guides

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Provider Services Call Center

  • Phone: 877-440-9946; available 8 a.m. – 5 p.m. Central Time, M-F

Provider Relations

Network Management Resource Team

  • To check the status of your credentialing application, Sign In with your One Healthcare ID. This allows you to access self-service tools or connect to a chat advocate for support. ​Please have the care provider’s full name, Tax ID, and National Provider Identifier (NPI) available.

Technical Support:

  • Phone: 866-209-9320

Behavioral Health Services

  • Phone: 877-440-9946 available 8 a.m. – 5 p.m. Central Time, M-F
  • Online: providerexpress.com

Pharmacy Services:

  • Pharmacies call: 844-495-8038
  • Prescribers requesting Pharmacy Prior Authorization call: 800-310-6826 or submit prior authorization through CoverMyMeds or SureScripts.

UnitedHealthcare Dental:

MARCH Vision Care:

MTM for Nonemergency Medical Transportation Services

  • Phone: 888-444-1519
    Call to schedule two days in advance

 

For questions about Credentialing and Attestation updates, connect with us through chat 24/7 in the UnitedHealthcare Provider Portal.

UnitedHealthcare Community Plan of Minnesota (UHCCP) recognizes doulas as a crucial part of maternal health care and an evidence-based solution to help improve birth outcomes. UHC follows MHCP Programs (MHCP) and covers doula services provided by doulas for fee-for-service (FFS) members. These services include emotional and physical support for pregnant women.

Eligible providers
Doulas must be contracted and credentialed in accordance with our Credentialing Plan.

Eligible Members
All pregnant UHCCP members are eligible to receive doula services from certified providers. Before rendering services to a member please confirm patient eligibility and benefits including plan requirements, preventive care and other care opportunities. Also determine if the service requires prior authorization, notifications or referrals, accessing our portal UHCProvider.com/benefits or calling Provider Services at 877-440-9946.

Covered Services
Covered services are limited to childbirth education and support services, which include emotional and physical support provided at the following times:

  • Before childbirth (antepartum)
  • Labor and delivery
  • Postpartum

UHCCP covers up to seven sessions, one of which must be for labor and delivery. The remaining six sessions may be used in the antepartum and postpartum periods as needed. Interpretation services are covered.

Noncovered Services
Travel time and mileage are not covered services.

Authorization Requirements
 Prior Authorization is not required for Doula services.

Timely filing
The general rule for claims submission is 6 months from the date of service, with the exception of newborn claims that have 12 months from the newborn’s date of birth. Corrected claims can be submitted 12 months from date of service.

Billing
UHCCP follows MHCP’s billing guidelines.

You may submit claims by electronic data interchange (EDI) using your Clearing House or through our UnitedHealthcare Provider Portal. Our payer ID is 87726. Additional information on UHCCP billing guidelines can be found at Claims and Payments.

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. You can register at Provider portal registration | UHCprovider.com.

Electronic payment solution: Optum Pay™
UHCCP 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 through Optum Pay, our preferred method of payment, or to receive a Virtual Card payment (Virtual Card). For more information on how to enroll visit Electronic Payment Options.

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.

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 Eligible Members.

Billing Housing Stabilization Services
Once you are registered with DHS MHCP as an HSS provider and have an approved letter, your claims will be eligible for reimbursement. 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 found at Housing Stabilization Services (state.mn.us).

Timely Filing
Claims for HSS are considered fee for service, with the rates and diagnoses established by DHS MHCP.  UnitedHealthcare follows Sec. 256B.69 MN Statutes,  initial claims should be submitted within 6 months from date of service.  Corrected claims have 12 months from date of service or 6 months from payment date. 

Provider Validation
Because HSS providers don’t need to contract with UnitedHealthcare to be added to our systems, it is required provider validation not credentialing; your first claim submission, W9 and practice information is considered your provider validation.  Your agency can be validated through electronic or paper claim submission.

1.      Electronic submission for validation: If you have access to submit your first claim electronically:

a. If you submit your first claim via EDI transaction (Waystar, MNeConnect, etc.) our Payer ID is 87726;  you will also have to submit your W9 and additional information registering at  Out-of-Network registration. Full training can be found at  Out of Network Validation: self-paced guide.  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.

2.      Paper submission for validation: If you don’t have access to submit your first claim electronically:

a. If you submit your first claim on paper using the CMS 1500 form, mail it along with a copy of your W9 to UnitedHealthcare Community Plan, P.O. Box 5270, Kingston, NY 12402-5270, a sample of the form and instructions on how to fill it can be found at CMS 1500 Sample. Once UHC receives the paper claim, the Provider Validation team will process the claim; when you receive the Provider Remit Advice you will know you have been validated, 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.

 i.     i. When you bill the paper claim make sure you add the G2 qualifier and your UMPI number, if you use UMPI vs. NPI, this will let us know that you bill with the State (UMPI) number. 

•  UMPI Number example

Claim submission after Provider Validation:

  • Claim submission using UnitedHealthcare Portal:
    • Registering for the UnitedHealthcare Portal:
      • If your TIN is approved, you can start using the tools and information on the UnitedHealthcare Provider Portal, including submitting and viewing claims and more.
        • Start your registration here after you have been validated (TIN approved). 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)
          • Copy of your W9
          • Proof of servicing address (i.e., Utilities bill)

Learn more about the portal and access training at UHCprovider.com/portal.

Billing for Remote Support
Remote support is a direct service with the person through phone, text, or video conferencing, previously only captured in case notes.  

Effective February 1st of 2024, HSS Providers will need to add a U4 modifier to the below Healthcare Common Procedure Codes (HCPCs), when HSS services are provided remotely. This change is for monitoring purposes. UnitedHealthcare follows DHS guidelines Housing Stabilization Services (state.mn.us) for Remote Support billing.

  • Housing Transition (H2015 U8)
  • Housing Sustaining (H2015 U8 TS)
  • Housing Consultation (T2024 U8)

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 sent to the billing address on file. To learn more please visit Optum Electronic Payment Solutions.

Register for email updates

The federal 21st Century Cures Act requires all Medicaid managed care organization (MCO) contracted network providers be screened and enrolled with State Medicaid programs.

The Minnesota Department of Human Services (DHS) previously announced MCO network providers must enroll with Minnesota Health Care Programs (MHCP) by July 15, 2024, (see https://mn.gov/dhs/health-care/provider-news).  This included rendering, ordering, referring, and prescribing (ORP) providers of services to managed care members (depending on specialty).

DHS has extended the enrollment requirement date to September 16, 2024.  You must enroll with MHCP or your claims may deny starting October of 2024. Enrolling with MHCP does not mean you are required to deliver services to fee-for-service members.

To ensure you are compliant with the federal mandate, submit your enrollment application as soon as possible.  If you receive this letter from multiple managed care plans, you only need to submit a single MHCP enrollment request.

Refer to the Eligible Providers section of the MHCP Provider Manual page at https://mn.gov/dhs/health-care/eligible-providers for a list of provider types that can enroll and instructions for how to enroll.

Refer to the Minnesota Provider Screening and Enrollment (MPSE) portal training webpage at mn.gov/dhs/m​ hcp/provider-training/mpse for training on how to use the MPSE portal to enroll.

Refer to the “Enrollment process for MCO network providers” section of the Enroll with MHCP webpage at https://mn.gov/dhs/partners-and-providers/enroll-with-mhcp for additional information.

Contact the MHCP Provider Resource Center at https://mn.gov/dhs/health-care/provider-resources with any additional questions.

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.

Coming Soon

Coming Soon

Effective April 1, 2024, UnitedHealthcare is implementing the Moving Expenses program for eligible UnitedHealthcare Community Plan members in Minnesota.

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):

  • Adult day services
  • Family adult day services
  • Customized living/24-hour customized living services

A list of these providers is included in the https://mhcpproviderdirectory.dhs.state.mn.us/. 

Questions?

Call Provider Services: 877-440-9946

CommunityCare

The best way for primary care providers (PCPs) to view and export the full member roster is using the CommunityCare feature on the UnitedHealthcare Provider Portal, which allows you to:  

  • Identify Medicaid recipients who need to have their Medicaid recertification completed and approved by the state 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
  • View most Medicaid and Medicare Special Needs Plans (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 feature on the UnitedHealthcare Provider Portal, please see our Quick Reference Guide. If you’re not familiar with UnitedHealthcare Provider Portal, visit our Portal Resources page.

Go to CommunityCare Now
CommunityCare Overview

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. 

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.