UnitedHealthcare Community Plan of New Jersey 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.”
In most areas, prior authorization requirements, concurrent utilization reviews for inpatient admissions and prior authorization required for placement in post-acute care settings resumed on May 26, 2020. This is consistent with the Governor of New Jersey’s Executive Order No. 145 permitting the resumption of elective and other surgical procedures.
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.
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.
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.
Deficit Reduction Act / False Claims – NJ Specific Policy
This 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.
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.
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.
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.