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.
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(800) 600-9007
Monday-Friday, 8 a.m. – 5 p.m.
UnitedHealthcare Community Plan
9200 Worthington Road, 3rd Floor
Westerville, OH 43082
UnitedHealthcare Community Plan
P.O. Box 8207
Kingston, NY 12402
UnitedHealthcare Community Plan
Attn: Complaint and Appeals Department
P.O. Box 31364
Salt Lake City, UT 84131
Fax: (801) 994-1082
UnitedHealthcare Community Plan
Attn: Complaint and Appeals Department
P.O. Box 31364
Salt Lake City, UT 84131
Fax: (801) 994-1082
Part C Appeals or Grievances:
UnitedHealthcare Community Plan
Attn: Complaint and Appeals Department
P.O. Box 31364
Salt Lake City, UT 84131
Fax: (801) 994-1082
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
Medicare Part D Appeals:
UnitedHealthcare Community Plan
Attn: Part D Standard Appeals
P.O. Box 6103
Cypress, CA 90630-9998
Fax: (877) 960-8235
For Credentialing and attestation updates, visit the Ohio Department of Medicaid website.
External medical review (EMR) is a review process conducted by an independent, external medical review entity. It is initiated by a provider who disagrees with the decision of a managed care organization (MCO) and/or the OhioRISE (Resilience through Integrated Systems and Excellence) plan to deny, limit, reduce, suspend or terminate a covered service for lack of medical necessity.
If you would like more information on EMRs, the Ohio Department of Medicaid (ODM) provides some helpful provider resources, including Frequently Asked Questions (FAQs), a Prior Authorization Denial Grid and the EMR process flow. All can be found on the ODM website.
Stay informed on the latest winter respiratory illness trends by subscribing to the Optum® Infectious Disease Platform (IDP) reporting email. With this near-real time data, you can make critical patient care decisions quicker.
The CDC recommends that everyone 6 months and older receive a flu vaccine each season, with few exceptions. Children 6 months through 8 years old may need 2 doses for best protection.
Thank you for your interest in joining the UnitedHealthcare Community Plan of Ohio network. In joining our network, you’ll become part of a group of health care professionals and facilities who share our commitment to helping Ohio members live healthier lives and making the health care system better for everyone.
There are 3 key phases to joining the network:
Need help? If you have questions about the process, connect with us through chat in the UnitedHealthcare Provider Portal or call UnitedHealthcare Community Plan of Ohio Provider Services at 800-600-9007.
To begin the contracting process:
Onboarding process
For more information, please view our Home and Community-Based Service (HCBS) and Long-Term Services and Support (LTSS) interactive guide.
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.
Visit UHCCommunityPlan.com/OH 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/OH and myuhc.com/communityplan.
The best way for primary care providers (PCPs) to view and export the full member roster is using the CommunityCare feature on the UnitedHealthcare Provider Portal, which allows you to:
For help using CommunityCare feature in the UnitedHealthcare Provider Portal, please see our user guide. If you’re not familiar with UnitedHealthcare Provider Portal, visit our portal resources page.
The Ohio provider contract with United HealthCare Community Plan is listed below.
Effective Oct. 20, 2023, Next Generation Medicaid managed care organizations (MCOs), the OhioRISE plan and MyCare Ohio plans must use provider data from Ohio Medicaid’s Provider Network Management (PNM) module as the official system of record. Health care professionals must keep their records updated within the PNM module. If your data in the PNM module does not match the data on your submitted claims, your claims will be denied for payment.
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.
UnitedHealthcare Dual Complete Special Needs Plans (DSNP) offer benefits for people with both Medicare and Medicaid. These DSNP plans provide benefits beyond Original Medicare, and may include transportation to medical appointments and vision exams. Members must have Medicaid to enroll.
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 HCPCS and CPT®-4 codes.
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.
If UnitedHealth Group 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 Policies and Clinical Guidelines section at left.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
CPT® is a registered trademark of the American Medical Association.