Welcome to the Home for Care Provider Resources

For UnitedHealthcare Community Plan of Nebraska

Welcome

For UnitedHealthcare Community Plan of Nebraska

UnitedHealthcare Community Plan of Nebraska 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.

Prior Authorization and Notification Resources

Current Policies and Clinical Guidelines

Provider Administrative Manual and Guides

Provider Call Center

866-331-2243, available Monday - Friday from 7:00 am - 8:00 pm CST (6:00 am - 7:00 pm MST)

Mailing Address

UnitedHealthcare Community Plan
2717 N 118th Street, Suite 300
Omaha, NE 68164

Claims Mailing Address

UnitedHealthcare
PO Box 31365
Salt Lake City, UT 84131

Utilization Denial & Appeals Department Mailing Address

National A&G Service Center
PO Box 31365
Salt Lake City, UT 84131
Claims Appeals Mailing Address

Appeals

UnitedHealthcare Community Plan Appeals
PO Box 31365
Salt Lake City, UT 84131

Provider Advocates

Nebraska Provider Advocates Contact Sheet

For Credentialing and Attestation updates, contact the National Credentialing Center at 1-877-842-3210.

The Heritage Health Adult program expands Medicaid coverage to adults ages 19 to 64 whose income is at or below 138 percent of the federal poverty level. Heritage Health Adult members are enrolled in managed care plans through the existing Heritage Health Program.

Benefit Tier Requirements

Unlike existing Medicaid-eligible individuals participating in the Heritage Health program, Heritage Health Adult members have a tiered benefit system with all eligible members receiving either Basic or Prime benefits.

  • Basic benefits include comprehensive medical, behavioral health and prescription drug coverage.
  • Prime benefits include Basic benefits plus vision, dental and over-the-counter medications. Heritage Health Adult members will receive Prime benefits if they’re one or more of the following:
    • Medically frail
    • Ages 19 or 20
    • Pregnant

Medically Frail Criteria

To be determined medically frail, the member must either:

  • Have a documented condition attested to by a qualified health care provider
  • Be identified through analysis and evaluation of historical claims data performed by a Medicaid managed care organization or information supplied by the Nebraska Department of Human Health and Human Services (DHHS) that falls into one or more of the following categories:
    • A disabling mental disorder (including serious mental illness)
    • A chronic substance abuse disorder
    • A physical, intellectual or developmental disability with functional impairment preventing the member from performing one or more activities of daily living for each activity occurrence
    • A disability determination based on Social Security criteria
    • A serious and complex medical condition(s)
    • Chronically homeless defined by the Department of Housing and Urban Development

Care Provider Requirements

Nebraska DHHS uses an attestation form to determine if a Heritage Health Adult member is medically frail. If you’re a care provider with diagnosing capabilities within your scope of practice, and you have a patient you believe meets the medically frail criteria, you’re required to complete the Medically Frail Attestation Form and send it to DHHS using one of the following methods:

  • Online: Upload it to dhhs.ne.gov/pages/accessnebraska.aspx
  • Email: dhhs.medfrailreview@nebraska.gov
  • Mail:

Attn: Heritage Health Adult Medically Frail Determinations

P.O. Box 95026

Lincoln, NE 68509

Resources:

Nebraska DHHS also has information on the Medicaid expansion available at dhhs.ne.gov.

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 is found in the UnitedHealthcare Community Plan Care Provider Manuals.  

Learn about requirements for joining our network

Visit UHCCommunityPlan.com/NE 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 - Heritage Health

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

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.

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.  

Current News, Bulletins and Alerts

Medical Policy Documentation Requirement Updates Frequently Asked Questions - UnitedHealthcare Community Plans

Last Modified | 10.20.2020

We’ve refined medical policy documentation requirements and enhanced clinical coverage criteria for various procedures. This document contains information on effective dates by state and frequently asked questions.

Learn More
4th Quarter 2020 Preferred Drug List Updates- UnitedHealthcare Community Plans

Last Modified | 09.18.2020

UnitedHealthcare Community Plan’s Preferred Drug List (PDL) is updated quarterly by our Pharmacy and Therapeutics Committee. Please review the changes and update your references as necessary. The plan is for AZ, CA, HI, MD, NE, NV, NJ, NY, NY EPP, OH, PA CHIP, RI and VA.

Learn More
Nebraska Medicaid Temporary Non-Acute Stay Codes, Billing and Reimbursement Information - UnitedHealthcare Community Plan of Nebraska

Last Modified | 06.25.2020

To help providers and members during the COVID-19 national public health emergency, the Nebraska Division of Medicaid and Long-Term Care (MLTC) developed a non-acute stay service to accommodate patients that can’t be cared for in existing settings.

Learn More
View More News

HEDIS Medical Record Collection

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. View our updated HIPAA information for UnitedHealthcare Community Plan.

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.