Ohio Care Provider Manual

Physician, Health Care Professional, Facility and Ancillary Care
Ohio: Medicaid and UnitedHealthcare Connected

 

Welcome

Welcome to the UnitedHealthcare Community Plan provider manual. This up-to-date reference manual allows you and your staff to find important information such as how to process a claim and submit prior authorization requests. This manual also includes important phone numbers and websites on the How to Contact Us page.

Find operational policy changes and other electronic tools on our website at UHCprovider.com.

Click the following links to access different manuals:

  • UnitedHealthcare Administrative Guide for Commercial and Medicare Advantage member information. Some states may also have Medicare Advantage information in their Community Plan manual.
  • A different Community Plan manual: go to UHCprovider.com. Click Menu on top left, select Administrative Guides and Manuals, then Community Plan Care Provider Manuals, select state.

If there is a conflict between your Agreement and this care provider manual, use this manual unless your Agreement states you should use it, instead. If there is a conflict between your Agreement, this manual and applicable federal and state statutes and regulations and/ or state contracts, applicable federal and state statutes and regulations and/or state contracts will control.

UnitedHealthcare Community Plan reserves the right to supplement this manual to help ensure its terms and conditions remain in compliance with relevant federal and state statutes and regulations.

This manual will be amended as policies change. 

Terms and definitions as used in this manual:

  • “Member” or “customer” refers to a person eligible and enrolled to receive coverage from a payer for covered services as defined or referenced in your Agreement.
  • “You,” “your” or “provider” refers to any health care provider subject to this manual, including physicians, health care professionals, facilities and ancillary providers; except when indicated and all items are applicable to all types of health care providers subject to this guide.
  • Community Plan refers to UnitedHealthcare’s Medicaid plan
  • “Your Agreement,” “Provider Agreement” or “Agreement” refers to your Participation Agreement with us.
  • “Us,” “we” or “our” refers to UnitedHealthcare Community Plan on behalf of itself and its other affiliates for those products and services subject to this guianualde.
  • Any reference to “ID card” includes both a physical or digital card.

Questions About Material?

If you have questions about this manual or about our policies, please call Provider Services. See How to Contact Us at bottom of page.

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Looking for a different state Community Plan (Medicaid) Care Provider Manual?

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How to Contact Us

Optum providerexpress.com

providerexpress.com

866-209-9320 (toll-free)

Eligibility, claims, benefits, authorization and appeals.

Refer members for behavioral health services. A PCP referral is not required.

UHCprovider.com/benefits

800-600-9007

Confirm a member’s benefits and/or prior authorization.

Medical Care Management Services: 800- 508-2581

Call Monday through Friday, 8 a.m. to 5 p.m., Central Time.

Behavioral Health Care Management: 866-261-7692

Call 24 hours a day, 7 days a week for help with with referrals, prior authorizations, admissions, discharges and coordination of members’ care.

myoptumhealthphysicalhealth.com

800-873-4575

We provide members older than 21 with up to six visits per calendar year with an in-network chiropractor. This benefit does not need prior authorization.

Use the Link Provider Portal at UHCprovider.com/claims

800-600-9007

Mailing address:

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

Verify a claim status or get information about proper completion or submission of claims.

See the Overpayment section for requirements before sending your request.

Sign in to UHCprovider.com/claims to access Link, then select the UnitedHealthcare Online app

800-600-9007

Mailing address:

UnitedHealthcare Community Plan
ATTN: Recovery Services
P.O. Box 740804 Atlanta, GA 30374-0800

Ask about claim overpayments.

DentaQuest: 800-341-8478

Call DentaQuest to find a network provider.

Fax 866-839-8058

Fax requests for medically necessary durable medical equipment.

To access the app, sign in to UHCprovider.com/eligibility to access Link, then select the UnitedHealthcare Online app

Interactive Voice Response 888-586-4766

Confirm member eligibility online or call our toll- free Interactive Voice Response (IVR) system 24 hours a day, 7 days a week.

877-842-3210

The Enterprise Voice Portal provides self-service functionality or call steering prior to speaking with a contact center agent.

877-766-3844 or 877-401-9430

Notify us of suspected fraud or abuse by a care provider or member.

800-599-5985

Refer high-risk OB members. Fax initial prenatal visit form.

UHCprovider.com > Find Dr > Preferred Lab Network

LabCorp: 800-833-3984

Quest Diagnostics: questdiagnostics.com

LabCorp and Quest Diagnostics are network laboratories.

Sign in to UHCprovider.com/claims to access Link, then select the UnitedHealthcare Online app

800-600-9007

Reconsiderations mailing address:

UnitedHealthcare Community Plan
P.O. Box 8207
Kingston, NY 12402-5240

Appeals mailing address:

UnitedHealthcare Community Plan Grievances and Appeals
P.O. Box 31364
Salt Lake City, UT 84131-0364

Claim issues include overpayment, underpayment, payment denial, or an original or corrected claim determination you don’t agree with.

Medicaid: 800-895-2017 Relay 711 (TTY)

7 a.m. – 7 p.m. Central Time, Monday through Friday.

MyCare: 877-542-9236 (TTY 711)

8 a.m. – 8 p.m. Central Time, Monday through Friday. Voicemail available 24 hours a day, seven days a week.

Assist members with issues or concerns.

866-261-7692

Refer members for behavioral health services. (A PCP referral is not required.)

*See Behavioral Health row for more information.

Member Services

Medicaid: 800-895-2017 Relay 711 (TTY)

7 a.m. – 7 p.m. Central Time, Monday through Friday.

MyCare: 877-542-9236 (TTY 711)

8 a.m. – 8 p.m. Central Time, Monday through Friday. Voicemail available 24 hours a day, seven days a week.

877-842-3210

Self-service functionality to update or check credentialing information.

800-600-9007

Ask about contracting and care provider services.

888-980-8728 or TTY 711 for hearing impaired

Available 24 hours a day, seven days a week.

Healthy First Steps 800-599-5985

Fax: 877-353-6913

UHCBabyBlocks.com

Links for pregnant moms and newborn babies.

LinkSupport@optum.com

855-819-5909

Available 7 a.m. – 9 p.m. Central Time, Monday through Friday; 6 a.m. – 6 p.m. Central Time, Saturday; and 9 a.m. – 6 p.m. Central Time, Sunday.

professionals.optumrx.com

877-305-8952 (OptumRx)

Technical Help Desk (pharmacies call): 877-305-8952

OptumRx oversees and manages our network pharmacies.

UHCprovider.com > Prior Authorization and Notification > Clinical Pharmacy and Specialty Drugs

Medicaid: 800-310-6826

Fax: 866-940-7328

MyCare: 800-711-4555

Provider Pharmacy Prior Authorization Help Desk: 800-310-6826

Help Desk Fax: 866-940-7328

Request authorization for medications as required.

Use Link to access the PreCheck MyScript tool. Request prior authorization and receive results, and see which prescriptions require prior authorization or are not covered or preferred Check coverage and price, including lower-cost alternatives.

UHCprovider.com > Prior Authorization and Notification

Medicaid: 866-604-3267

Fax: 866-622-1428

MyCare: 800-366-7304

Request authorization/notify of the procedures and services outline in the prior authorization/ notification requirements section of this manual.

Complete and current list of prior authorizations.

UHCprovider.com/priorauth > Prior Authorization Notification Tool

877-842-3210

The process for completing the notification/ prior authorization request and time frames remains the same. Learn how to use the prior authorization advanced notification (PAAN) tool, complete the notification/prior authorization process or confirm a coverage decision.

Call 7 a.m. to 7 p.m. local time, Monday through Friday.

UHCprovider.com/OHcommunityplan

800-600-9007

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

Available 8 a.m. – 5 p.m. Central Time, Monday through Friday.

UHCprovider.com > Prior Authorization and Notification > Radiology

866-889-8054

Request prior authorization of the procedures and services outlined in this manual’s prior authorization requirements.

Complete and current list of prior authorizations.

UHCprovider.com > Click Menu on top left, then select Referrals or use Link Provider Services

800-600-9007

UHCprovider.com/OHcommunityplan > Bulletins and Newsletters

Reimbursement policies that apply to UnitedHealthcare Community Plan members. Visit this site often to view reimbursement policy updates.

800-784-8669

Ask about services for quitting tobacco / smoking.

MTM 800-269-4190

Call Member Services to schedule transportation or for transportation assistance through MTM.  To arrange non-urgent transportation, please call three days in advance.

800-366-7304

UM helps avoid overuse and under-use of medical services by making clinical coverage decisions based on available evidence-based guidelines.

Request a copy of our UM guidelines or information about the program.

800-219-3224

Care providers must participate in the VFC Program administered by the Department of Health and Senior Services (DHSS) and must use the free vaccine when administering vaccine to qualified eligible children. Providers must enroll as VFC providers with DHSS to bill for the administration of the vaccine.

March Vision marchvisioncare.com

844-756-2724

Prior authorization is required for all routine eye exams and hardware. Authorizations must be obtained from March Vision.

UHCprovider.com/OHcommunityplan

Access your state-specific Community Plan information on this website.

800-508-2581

Refer high-risk members (e.g., asthma, diabetes, obesity) and members who need private-duty nursing.