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For UnitedHealthcare Community Plan of New York

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For UnitedHealthcare Community Plan of New York

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UnitedHealthcare Community Plan of New York 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

866-362-3368

Mailing Address

UnitedHealthcare Community Plan
77 Water Street, 14th Floor
New York, NY 10005

Claims Mailing Address

UnitedHealthcare Community Plan
PO Box 5240
Kingston, NY 12402-5240

Utilization Management Appeals Address

UnitedHealthcare Community Plan
PO Box 31364
Salt Lake City, UT 84131-0364
Fax: (801) 994-1082

Claims Appeals Mailing Address

Part C Appeals or Grievances

UnitedHealthcare Community Plan
Attn: Complaint and Appeals Department
P.O. Box 31364
Salt Lake City, UT 84131-0364
Fax: (801) 994-1082

Medicare Part D Appeals

UnitedHealthcare Community Plan
Attn: Part D Standard Appeals
P.O. Box 6103
Cypress, CA 90630-9998
Fax: (877) 960-8235

Medicare Part D Grievances

UnitedHealthcare Community Plan
Attn: Complaint and Appeals Department
P.O. Box 31364
Salt Lake City, UT 84131
Fax: (801) 994-1082

For Credentialing and Attestation updates, contact the National Credentialing Center at 1-877-842-3210.

Facility/Hospital-Based Providers, Group/Practice Providers and Individually-Contracted Clinicians

Learn about requirements for joining our network.

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.

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

Visit UHCCommunityPlan.com/NY for current member plan information including sample member ID cards, provider directories, dental plans, vision plans and more.

Plan information is available for:

  • New York Child Health Plus
  • New York Community Plan MLTSS
  • New York Essential Plan
  • New York UnitedHealthcare Community Plan
  • New York UnitedHealthcare Wellness4Me

Member plan and benefit information can also be found at UHCCommunityPlan.com/NY and myuhc.com.

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, UnitedHealthcare works to detect, correct and prevent fraud , waste  and abuse  in the health care system.

Call us at 1-844-359-7736 or at uhc.com/fraud to report any issues or concerns. 

Current News, Bulletins and Alerts

Prior Authorization for Referrals of Non-Urgent/Emergent Services: Important Reminder to Care Providers

Last Modified | 10.09.2019

As a reminder, if you are a participating provider, you’re required to coordinate member care within the UnitedHealthcare Community Plan network. We put this requirement in place to help our members keep their costs down and reduce the frequency of surprise bills.

Learn More
Reimbursement Notice for Evaluation and Management Services Performed During for UnitedHealthcare Community Plan of AZ, CA, HI, KS, MA, MI, MO, NJ, NY, VA, WA, and WI

Last Modified | 09.20.2019

We’re letting you know about an issue with our Obstetrical Services Professional Reimbursement Policy. When it comes to evaluation and management services performed during global obstetrical care, UnitedHealthcare Community Plan allows up to three evaluation and management services in addition to the global obstetrical package, depending on state regulations, when billed with a pregnancy-related diagnosis.

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FAQs: Prior Authorization Requirements for Certain Therapy Services - UnitedHealthcare Community Plan of New York

Last Modified | 09.03.2019

UnitedHealthcare Community Plan of New York aims to improve cost efficiencies for the overall health care system. We’re revising our existing prior authorization requirements and this document is a listing of FAQs for certain therapy services, effective Oct. 1 or Nov. 1, 2019.

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DUR Educational Newsletter: Opioid and Buprenorphine Use for Treating Opioid Use Disorder

Last Modified | 08.16.2019

Buprenorphine and full opioid agonists should not be used together to treat opioid use disorder.

Learn More
New York Winter 2018 Practice Matters

Last Modified | 08.08.2019

We hope you enjoy this edition of Practice Matters. In this issue, you can read about the Dual Special Needs Plan expansion, Preferred Drug List updates, managing the care of your patients, and more.

Learn More
View More News

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.