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.

The Heritage Health Adult (HHA) program expands Medicaid coverage to adults, ages 19–64, whose income is at or below 138% of the federal poverty level. HHA 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, HHA 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

Several individuals eligible for HHA will have comorbidities (underlying health conditions), undiagnosed or uncontrolled mental health disorders and social determinants of health that may be barriers to improving their health. Individuals who are determined to be medically frail by the Department of Health and Human Services (DHHS) will receive Prime benefits. A member enrolled in HHA with Basic benefits can request a review by DHHS for medically frail status. DHHS will notify the member on whether they qualify for medically frail status. A medically frail determination is effective for either one or three years, depending on the individual’s diagnosis.

Diagnoses/conditions that can lead to a medically frail determination include:

• A disabling mental health disorder
• A chronic substance abuse disorder
• A physical, intellectual or developmental disability with functional impairment that significantly impairs one from performing one or more activities of daily living each time the activity occurs
• A disability determination based on Social Security criteria
• A serious and complex medical condition
• Chronically homeless as defined by the United States of Housing and Urban Development

Care provider responsibilities

Nebraska DHHS uses an attestation form to determine if an HHA 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 can 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: Nebraska DHHS
  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. 

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. 

• Known Issues Log

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.

Search for a care provider by plan name:

• UnitedHealthcare Community Plan - Heritage Health
• UnitedHealthcare Dual Complete®
  

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.  

• Nebraska Department of Health & Human Services
• Nebraska’s Heritage Health Program