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.”
888-362-3368, available Monday – Friday from 6:00 a.m. – 6:00 p.m.
UnitedHealthcare Community Plan
P.O. Box 5250
Kingston, NY 12402-5250
Payer ID: 86047
UnitedHealthcare Dual Complete® ONE
P.O. Box 5250
Kingston, NY 12402-5250
Payer ID: 86047
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
UnitedHealthcare Community Plan
Attn: UM Appeals Coordinator
P.O. Box 31364
Salt Lake City, UT 84131
UnitedHealthcare Dual Complete One
Attn: UM Appeals Coordinator
P.O. Box 31364
Salt Lake City, UT 84131
For Credentialing and Attestation updates, contact the National Credentialing Center at 1-877-842-3210.
All documentation, inquires, and communication related to MLTSS credentialing and recredentialing information can be emailed to us at NJ_MLTSS_CRED@uhc.com.
Learn how to join the Behavioral Health Network, review Community Plan Behavioral Health information, or submit demographic changes at Community Plan Behavioral Health.
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.
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:
Member plan and benefit information can also be found at UHCCommunityPlan.com/NJ and myuhc.com/communityplan.
Search for a care provider by plan name:
The Centers for Medicare & Medicaid Services (CMS) established the Medicaid Managed Care Rule to:
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:
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.
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.
If any provider or person discovers fraud and/or abuse occurring in any State or federally-funded health benefit program, they should report it to the Office of State Comptroller, New Jersey Medicaid Fraud Division hotline at 1-888-937-2835 or website at http://nj.gov/comptroller/divisions/medicaid.
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.
Last Modified | 05.16.2022
Health care professionals who wish to contract with UnitedHealthcare Community Plan may need a site visit as part of the credentialing process.
Learn MoreLast Modified | 05.01.2022
Effective Aug. 1, 2021, UnitedHealthcare Community Plan of New Jersey will deny DME claims that don't meet the DME Medicare Administrative Contractor (MAC) criteria.
Learn MoreLast 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 MoreLast Modified | 04.28.2022
Effective July 1, 2022, prior authorization will be required for certain outpatient radiation therapies for UnitedHealthcare New Jersey Community Plan Medicaid members.
Learn MoreLast Modified | 04.25.2022
Effective Aug. 1, 2022, you’ll see new codes on the prior authorization list for cardiovascular, prostate, and spinal surgery procedures. These changes impact UnitedHealthcare Community Plan of New Jersey’s Medicaid and Long-Term Care plans.
Learn MoreLast Modified | 05.16.2022
Health care professionals who wish to contract with UnitedHealthcare Community Plan may need a site visit as part of the credentialing process.
Learn MoreLast Modified | 05.01.2022
Effective Aug. 1, 2021, UnitedHealthcare Community Plan of New Jersey will deny DME claims that don't meet the DME Medicare Administrative Contractor (MAC) criteria.
Learn MoreLast 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 MoreLast Modified | 04.28.2022
Effective July 1, 2022, prior authorization will be required for certain outpatient radiation therapies for UnitedHealthcare New Jersey Community Plan Medicaid members.
Learn MoreLast Modified | 04.25.2022
Effective Aug. 1, 2022, you’ll see new codes on the prior authorization list for cardiovascular, prostate, and spinal surgery procedures. These changes impact UnitedHealthcare Community Plan of New Jersey’s Medicaid and Long-Term Care plans.
Learn MoreThis Policy requires Employees (and Employees of applicable contractors and agents of the Company) to comply with the federal False Claims Act, state false claims acts, and similar state and local laws and applicable agency policy. View our policy.
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.
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.
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.