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

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/communityplan.

Care Provider Search

Search for a care provider by plan name:

• New Jersey FamilyCare
• UnitedHealthcare Dual Complete® ONE

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.  

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.