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 Service Center
888-362-3368, available Monday – Friday from 6:00 a.m. – 6:00 p.m.
Claims Address
Medicaid and NJ Familycare
UnitedHealthcare Community Plan
P.O. Box 5250
Kingston, NY 12402-5250
Payer ID: 86047
UnitedHealthcare Dual Complete ONE
UnitedHealthcare Dual Complete® ONE
P.O. Box 5250
Kingston, NY 12402-5250
Payer ID: 86047
Claims Appeal Address
Part C Appeals and Grievance Department
UnitedHealthcare Community Plan
Attn: Complaint and Appeals Department
P.O. Box 31364
Salt Lake City, UT 84131-0364
Part D Appeals and Grievance Department
Attn: CA124-0197
P.O. Box 6106
Cypress, CA 90630-9948
UM Appeals
Medicaid and NJ Familycare
UnitedHealthcare Community Plan
Attn: UM Appeals Coordinator
P.O. Box 31364
Salt Lake City, UT 84131
UnitedHealthcare Dual Special Needs (HMO SNP)
UnitedHealthcare Dual Complete One
Attn: UM Appeals Coordinator
P.O. Box 31364
Salt Lake City, UT 84131
All Providers
For Credentialing and Attestation updates, contact the National Credentialing Center at 1-877-842-3210.
Credentialing and Recredentialing for Managed Long-Term Care Services and Supports (MLTSS) Providers
All documentation, inquires, and communication related to MLTSS credentialing and recredentialing information can be emailed to us at NJ_MLTSS_CRED@uhc.com.
- If you are a participating MLTSS provider, you need to send us your recredentialing documents each year to ensure we have your most current complete required documentation.
- All forms and documents can be emailed to NJ_MLTSS_CRED@uhc.com. Include the name of the facility and the words “Recredentialing Application” in the subject line.
- Documents can also be mailed to:
- UnitedHealthcare Community Plan
Attn: MLTSS Credentialing
283-289 Market Street 12th Floor, Suite 1202
Newark, NJ 07102
- UnitedHealthcare Community Plan
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.
Managed Long-Term Care Services and Supports (MLTSS) Providers
If you are interested in becoming a participating MLTSS provider, please email NJ_MLTSS_CRED@UHC.com for more information or to request a credentialing application. Include the name of the facility and the words “Credentialing Application” in the subject line.
Visit UHCCommunityPlan.com/NJ for current member plan information including sample member ID cards, provider directories, dental plans, vision plans and more.
Plan information is available for:
- New Jersey FamilyCare
- New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program
Member plan and benefit information can also be found at UHCCommunityPlan.com/NJ and myuhc.com.
Care Provider Search
Search for a care provider by plan name:
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
-
DUR Educational Newsletter: Safety in Respiratory Therapy - UnitedHealthcare Community Plan
Last Modified | 02.12.2020
The National Asthma Education and Prevention Program (NAEPP) published guidelines for the treatment of asthma in2007.¹ The guidelines outline goals of therapy that include the prevention of recurrent exacerbation and need for emergencydepartment or hospital care, the prevention of reduced lung growth in children or loss of lung function in adults, and theoptimization of pharmacotherapy with minimal or no adverse effects.
Learn More -
Prior Authorization for Out-of-State and Out-of-Network Services UnitedHealthcare Community Plan of New Jersey
Last Modified | 02.12.2020
Effective July 1, 2019, UnitedHealthcare Community Plan of New Jersey requires prior authorization for referrals and services at out-of-state and out-of-network care providers and facilities. Prior authorization requests for out-of-state and out-of-network services can only be submitted by phone.
Learn More -
Private Duty Nursing Prior Authorization Forms FAQ - UnitedHealthcare Community Plan of New Jersey
Last Modified | 12.10.2019
To help our members receive the quality care they need when they need it, we’ve implemented new private duty nursing (PDN) prior authorization requirements.
Learn More -
Billing Reminder for Coordination of Benefits Claims - UnitedHealthcare Community Plan of New Jersey
Last Modified | 02.04.2020
UnitedHealthcare Community Plan wants to make claim submission for reimbursement easier for our network care providers who provide services to members with primary insurance. Coordination of benefits (COB) is used when a member is covered by more than one insurance policy.
Learn More -
New Announcement: Private Duty Nursing - UnitedHealthcare Community Plan of New Jersey
Last Modified | 10.31.2019
To help our members receive the quality care they need when they need it, UnitedHealthcare Community Plan of New Jersey implemented new private duty nursing (PDN) prior authorization requirements on Sept. 15, 2019.
Learn More
DUR Educational Newsletter: Safety in Respiratory Therapy - UnitedHealthcare Community Plan
Last Modified | 02.12.2020
The National Asthma Education and Prevention Program (NAEPP) published guidelines for the treatment of asthma in2007.¹ The guidelines outline goals of therapy that include the prevention of recurrent exacerbation and need for emergencydepartment or hospital care, the prevention of reduced lung growth in children or loss of lung function in adults, and theoptimization of pharmacotherapy with minimal or no adverse effects.
Learn MorePrior Authorization for Out-of-State and Out-of-Network Services UnitedHealthcare Community Plan of New Jersey
Last Modified | 02.12.2020
Effective July 1, 2019, UnitedHealthcare Community Plan of New Jersey requires prior authorization for referrals and services at out-of-state and out-of-network care providers and facilities. Prior authorization requests for out-of-state and out-of-network services can only be submitted by phone.
Learn MorePrivate Duty Nursing Prior Authorization Forms FAQ - UnitedHealthcare Community Plan of New Jersey
Last Modified | 12.10.2019
To help our members receive the quality care they need when they need it, we’ve implemented new private duty nursing (PDN) prior authorization requirements.
Learn MoreBilling Reminder for Coordination of Benefits Claims - UnitedHealthcare Community Plan of New Jersey
Last Modified | 02.04.2020
UnitedHealthcare Community Plan wants to make claim submission for reimbursement easier for our network care providers who provide services to members with primary insurance. Coordination of benefits (COB) is used when a member is covered by more than one insurance policy.
Learn MoreNew Announcement: Private Duty Nursing - UnitedHealthcare Community Plan of New Jersey
Last Modified | 10.31.2019
To help our members receive the quality care they need when they need it, UnitedHealthcare Community Plan of New Jersey implemented new private duty nursing (PDN) prior authorization requirements on Sept. 15, 2019.
Learn MoreCurrent News, Bulletins and Alerts
-
DUR Educational Newsletter: Safety in Respiratory Therapy - UnitedHealthcare Community Plan
Last Modified | 02.12.2020
The National Asthma Education and Prevention Program (NAEPP) published guidelines for the treatment of asthma in2007.¹ The guidelines outline goals of therapy that include the prevention of recurrent exacerbation and need for emergencydepartment or hospital care, the prevention of reduced lung growth in children or loss of lung function in adults, and theoptimization of pharmacotherapy with minimal or no adverse effects.
Learn More -
Prior Authorization for Out-of-State and Out-of-Network Services UnitedHealthcare Community Plan of New Jersey
Last Modified | 02.12.2020
Effective July 1, 2019, UnitedHealthcare Community Plan of New Jersey requires prior authorization for referrals and services at out-of-state and out-of-network care providers and facilities. Prior authorization requests for out-of-state and out-of-network services can only be submitted by phone.
Learn More -
Private Duty Nursing Prior Authorization Forms FAQ - UnitedHealthcare Community Plan of New Jersey
Last Modified | 12.10.2019
To help our members receive the quality care they need when they need it, we’ve implemented new private duty nursing (PDN) prior authorization requirements.
Learn More
DUR Educational Newsletter: Safety in Respiratory Therapy - UnitedHealthcare Community Plan
Last Modified | 02.12.2020
The National Asthma Education and Prevention Program (NAEPP) published guidelines for the treatment of asthma in2007.¹ The guidelines outline goals of therapy that include the prevention of recurrent exacerbation and need for emergencydepartment or hospital care, the prevention of reduced lung growth in children or loss of lung function in adults, and theoptimization of pharmacotherapy with minimal or no adverse effects.
Learn MorePrior Authorization for Out-of-State and Out-of-Network Services UnitedHealthcare Community Plan of New Jersey
Last Modified | 02.12.2020
Effective July 1, 2019, UnitedHealthcare Community Plan of New Jersey requires prior authorization for referrals and services at out-of-state and out-of-network care providers and facilities. Prior authorization requests for out-of-state and out-of-network services can only be submitted by phone.
Learn MorePrivate Duty Nursing Prior Authorization Forms FAQ - UnitedHealthcare Community Plan of New Jersey
Last Modified | 12.10.2019
To help our members receive the quality care they need when they need it, we’ve implemented new private duty nursing (PDN) prior authorization requirements.
Learn More
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Learn MoreHEDIS Medical Record Collection
- HEDIS® Medical Record Collection - Frequently Asked Questions
- HEDIS® Medical Record Collection - Overview
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.