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For UnitedHealthcare Community Plan of Ohio

Welcome

For UnitedHealthcare Community Plan of Ohio

UnitedHealthcare Community Plan of Ohio 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.

Prior Authorization and Notification Resources

Current Policies and Clinical Guidelines

Provider Administrative Manual and Guides

COVID-19 Resources for Providers

 

Provider Call Center

(800) 600-9007
Monday-Friday, 8 a.m. – 5 p.m.

Postal Mailing Address

UnitedHealthcare Community Plan
9200 Worthington Road, 3rd Floor
Westerville, OH 43082

Claims Mailing Address

UnitedHealthcare Community Plan
P.O. Box 8207
Kingston, NY 12402

Utilization Management Appeals Address  

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

Claims Appeals Mailing Address

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

UHC Connected™ For MyCare Ohio 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
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, contact the National Credentialing Center at 1-877-842-3210.

Need to make a change to your provider or facility directory information? 

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

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.

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:

  • UnitedHealthcare Community Plan of Ohio
  • UnitedHealthcare Connected® for MyCare Ohio
  • UnitedHealthcare Dual Complete (HMO SNP)
  • UnitedHealthcare Dual Complete (HMO-POS SNP)

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

Search for a Care Provider 

Search for a Dentist

Need to make a change to your provider or facility directory information? 

The Ohio provider contract with United HealthCare Community Plan is listed below.

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.  

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.

Current News, Bulletins and Alerts

Retiring Admission Notification Fax Number Reminder for UnitedHealthcare Community Plan

Last Modified | 12.03.2020

Fax numbers that some acute and post-acute facilities use to notify us when UnitedHealthcare Community Plan members have been admitted will be retired on Dec. 1, 2020. We first announced this change in the August Network Bulletin. You can find more information and a list of retiring numbers at UHCprovider.com/admit. As always, we will comply with contractual and regulatory requirements.

Learn More
Update to Multiple Procedure Payment Reduction (MPPR) for Diagnostic Cardiovascular and Ophthalmology Procedures Policy

Last Modified | 11.09.2020

We’re changing the way we currently reimburse claims based on our Multiple Procedure Payment Reduction (MPPR) for Diagnostic Cardiovascular and Ophthalmology Procedures Reimbursement Policy. The policy itself is not changing, but we’re resuming payment reductions based on the policy for claims processed on or after Nov. 27, 2018.

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Medical Policy Documentation Requirement Updates Frequently Asked Questions - UnitedHealthcare Community Plans

Last Modified | 10.20.2020

We’ve refined medical policy documentation requirements and enhanced clinical coverage criteria for various procedures. This document contains information on effective dates by state and frequently asked questions.

Learn More
Ohio Department of Medicaid Telehealth Unified Policy - UnitedHealthcare Community Plan of Ohio

Last Modified | 10.13.2020

In order to ensure that all Ohio Medicaid members have needed access to care, the Ohio Department of Medicaid (ODM) and Medicaid Managed Care Plans (MCPs) are increasing the scope and scale of reimbursement for telehealth services for Medicaid recipients during the duration of the COVID-19 emergency.

Learn More
Inappropriate Primary Diagnosis Policy, Facility - Effective November 1, 2020 - UnitedHealthcare Community Plan of AZ, FL, MD, MI, MS, OH, PA, TN, VA, and WI

Last Modified | 09.29.2020

UnitedHealthcare Community Plan is implementing a new Inappropriate Primary Diagnosis Policy, Facility, for facility claims with dates of services on or after November 1, 2020.

Learn More
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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.