Welcome to the New Home for Care Provider Resources

For UnitedHealthcare Community Plan of Nebraska

Welcome to the Home for Nebraska Community Plan Care Provider Resources

For UnitedHealthcare Community Plan of Nebraska

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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.”

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.

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.

Helpful Resources

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

Specialty Pharmacy Program for Rare or Complex Diseases

Last Modified | 11.05.2018

We’ll start using our Specialty Pharmacy Program to manage medications for rare or complex diseases beginning Oct. 15, 2018 for UnitedHealthcare Community Plan members in Nebraska. This program provides members with personalized support for medications they need to treat their medical condition.

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Update to the Emergency Department Facility Coding Policy – Beginning Dec. 15, 2018 - UnitedHealthcare Community Plan of Nebraska

Last Modified | 10.25.2018

To help reinforce accurate coding practices, UnitedHealthcare Community Plan will update our Emergency Department Facility E/M Coding Reimbursement Policy. This policy is based on CMS E/M coding principles that require hospital E/M codes to match CPT® code descriptions and reasonably relate to hospital resource use.

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Provider Alert: New Claims Policy - All Claims Must Have Valid Rendering and Billing Provider NPI Numbers, Starting Nov. 1, 2018

Last Modified | 10.10.2018

We strive to process your UnitedHealthcare Community Plan claims promptly. One way you can help us do this is by including all relevant information on your claims for Nebraska members, including a valid combination of billing and rendering National Provider Identifier (NPI) numbers. For dates of service on or after Nov. 1, 2018, all electronic and paper claims must have a valid rendering provider NPI number and billing provider NPI number combination that matches the care provider information enrolled with the Department of Health and Human Services (DHHS). Electronic claim submissions that do not have a matching rendering and billing provider NPI combination will be rejected and paper claims will be denied.

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UnitedHealthcare Community Plan of Nebraska Open Issues

Last Modified | 10.04.2018

If you have questions or concerns about the following issues, please email your provider advocate. Claims that have been rejected or denied appropriately will not be considered part of the below projects.

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Nebraska Practice Matters - Fall 2018

Last Modified | 09.24.2018

Practice Matters is a quarterly publication for physicians and other health care professionals and facilities in the UnitedHealthcare network.

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UHC On Air gives you in-depth program information and meaningful updates from UnitedHealthcare 24/7and from any device.

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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.