UnitedHealthcare Community Plan of North Carolina 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.
UnitedHealthcare Community Plan of North Carolina health care professional enrollment and credentialing is completed through NCTracks. NCTracks is the multi-payer Medicaid Management Information System for the North Carolina Department of Health and Human Services (NCDHHS).
The NCDHHS fiscal agent enrollment team, CSRA, verifies all your information, ensuring that you meet credentialing requirements and you’re in good standing. Once your participation in the program has been approved, you’ll be notified by email and can then begin submitting member claims.
For questions and application information, visit the NCTracks website.
To contract with the Community Plan of North Carolina – Medicaid please contact the NC Health Plan Provider Call Center at 800-638-3302.
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, you may also contact Optum Behavioral Health at 877-614-0484.
Facility/Hospital-Based Providers, Group/Practice Providers and Individually-Contracted Clinicians
The Known Issues Log is a current list of open and closed known global claims issues. For questions related to open issues, reach out to your Provider Advocate or call Provider Services at 800-638-3302.
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.
As a fraud, waste, and abuse detection tool, UnitedHealthcare uses the Recipient Explanation of Medical Benefits (REOMB) process to verify services were provided to members as billed. With this process, an explanation of benefits statement is sent to a random number of members. If you suspect fraud, waste, or abuse within the NC Managed Care Program as it relates to a UnitedHealthcare member or services provided, please call 1-800-638-3302.
UnitedHealthcare Dual Complete® Special Needs Plan
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.
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.