Welcome to the Home for Care Provider Resources

For UnitedHealthcare Community Plan of Nebraska

Welcome

For UnitedHealthcare Community Plan of Nebraska

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

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Provider Call Center

866-331-2243, available Monday - Friday from 7:00 am - 6:00 pm CST (6:00 am - 5:00 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.

Nebraska Medicaid and Long-Term Care (MLTC) has expanded Medicaid coverage under the Heritage Health Adult (HHA) Expansion program. The HHA program expands Medicaid coverage to adults, ages 19–64, whose income is at or below 138% of the federal poverty level. Heritage Health Adult members are enrolled in managed care plans through the existing Heritage Health program and are eligible for the same benefit package. This includes comprehensive medical, behavioral health and prescription drug coverage as well as vision services, dental services and over-the-counter (OTC) medication benefits.

Resources

The Nebraska Department of Health and Human Services (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

The Known Issues Log is a current list of open and closed known global claims issues. For questions related to open issues, reach out to your Provider Advocate or call Provider Services at 866-331-2243. 

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/communityplan.

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 | 05.16.2022

UnitedHealthcare has partnered with the Nebraska Perinatal Quality Improvement Collaborative (NPQIC) to reduce prematurity rates in Nebraska.

Learn More

Last Modified | 04.29.2022

Effective Aug. 1, 2022, Optum will manage prior authorization requests for non-oncology injectable medications that are covered on the medical benefit for UnitedHealthcare Community Plans.

Learn More

Last Modified | 04.25.2022

Effective June 1, 2022, we’re adding new codes to the prior authorization list for cardiovascular procedures, prostate procedures, spine surgery and cosmetic surgery procedures.

Learn More
View More News

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.