We offer the following services to our UnitedHealthcare Community Plan members. If you have questions or need to refer a member, call Provider Services at 800-600-9007 unless otherwise noted.
Evidence-based medicine supports chiropractic care to help lower back pain. In some cases, a visit to the chiropractor can reduce or eliminate the need for pain medication. It can even help combat opioid addiction and overuse.
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 following steps to access the fee schedules online:
- Go to myoptumhealthphysicalhealth.com.
- Enter your provider ID & password.
- Click “Tools & Resources.”
- Click “Plan Summaries” or “Fee Schedules.”
- The two covered CPT codes are 98940 and 98941.
Airwaze is a smartphone app that provides tailored asthma education, medication reminders and other self-management tools. This care management app is available for members age 5–18 who have and need help maintaining control of their asthma.
17P is a progesterone injection that helps lower the risk of pre-term labor. It is administered weekly beginning in the second trimester.
This program helps postpartum women and their newborns who have recently been discharged from the hospital. It offers:
- Maternal physical assessment.
- Staples removal.
- Newborn physical assessment, including physical well-being, parent-infant interactions, developmental and behavioral status, nutritional status, feeding and elimination patterns.
- Psychosocial assessment, including a screen for postpartum depression.
- Newborn attachment evaluation.
- Identification of cultural influences on the postpartum period.
- Environmental assessment.
- Breast- or bottle-feeding education.
- Information about the postpartum period and newborn care.
Baby Blocks™ is a web-based, mobile tool that reminds and rewards pregnant women and new mothers to get prenatal, postpartum and well-child care. Baby Blocks™ is available to pregnant UnitedHealthcare Community Plan members or their newborns.
Baby Blocks™ Benefit
Baby Blocks engages members with text and email appointment reminders. Members who enroll early in their pregnancy can earn up to eight rewards by following prenatal and postpartum recommendations.
How it Works
- Care providers and UnitedHealthcare Community Plan reach out to members to enroll them in Baby Blocks.
- Members enter information about their pregnancy and upcoming appointments at UHCBabyBlocks.com.
- Members get reminders of upcoming appointments and record completed visits at UHCBabyBlocks.com.
- At milestones throughout the program, members choose a reward for themselves or their baby.
How You Can Help
- Identify UnitedHealthcare Community Plan members during prenatal visits.
- Share a Baby Blocks brochure with the member and talk about the program.
- Encourage the member to enroll at UHCBabyBlocks.com.
Members self-enroll on a smartphone or computer. They can go to UHCBabyBlocks.com and click on “Register.”
We use educational materials and newsletters to remind members to follow positive health actions such as immunizations, wellness, and EPSDT screenings. For those members with chronic conditions, we provide specific information, including recommended routine appointment frequency, necessary testing, monitoring, and self-care through our disease management (DM) program. All materials are based upon evidence-based guidelines or standards. All printed materials are written at a fifth grade reading level. They are available in English as well as other languages. The materials are designed to support members as they begin to take responsibility for their health. They provide information necessary to successfully manage their condition and live a healthy lifestyle.
Members at highest risk with conditions such as asthma, CHF, diabetes, COPD and CAD receive more intense health coaching. Resources and tools are available to support members and caregivers with conditions common to children with special health care needs and help them manage their illness.
Identification – The health plan uses claims data (e.g. hospital admissions, ER visits, and pharmacy claims) to identify members with gaps in care and/or chronic conditions.
Referral – PCPs may make referrals to support practice- based interventions by contacting the Health Services team at 866-270-5785.
A Dental Provider Manual is available for detailed coverage information.
UnitedHealthcare Community Plan works with DentaQuest to cover the facility and anesthesia for medically necessary outpatient dental services for adults ages 21 and older. If older than 21, we do not provide coverage without the presence of trauma or cases where treatment is needed for serious medical conditions.
Facility services require a prior authorization. For more details, visit DentaQuest’s website at dentaquest.com.
To find a dental provider, go to UHCprovider.com > Find Dr > Dental Providers by state.
Early Intervention promotes the development of infants and toddlers with developmental challenges and delays. It also covers certain disabling conditions. The program provides services to eligible children from birth to 3 years old and their families.
On My Way
On My Way teaches youth aging out of foster care how to navigate the complex social support systems, including health care. Members can access On My Way through our care management system.
Youth in foster care often do not have access to the same kind of support and guidance of other teens. These youth struggle for independence while trying to make smart life decisions. This requires support and guidance, even for young adults who have grown up in a stable and supportive environment. Our interactive mobile and web-enabled game breaks the transition process into manageable steps and connects foster youth with the support/guidance they need and want (e.g., they can easily connect with peer support staff).
Peer Support Specialist
We have a foster-care peer support specialist working with youth in the foster care system and their families. The specialist works with the member and the family to define the member’s recovery goals. The specialist helps the member develop life skills and provides phone and/or face-to-face communications to members. The member and foster family receive support and help improve the member’s overall physical and behavioral health. This benefit can also help to reduce hospitalizations and ER visits related to behavioral conditions in youth in foster care services.
A smartphone app that helps educate members who receive Supplemental Nutrition Assistance Program (SNAP) Benefits by helping them to make healthy choices on a budget. The Fresh EBT app lets members check their balance quickly and easily, track spending habits, find places that accept EBT, locate grocery deals, keep a shopping list and get healthy low-cost recipes.
This web-based referral tool helps members gain access to food, housing, employment, energy, support groups, child care, and clothing. It is for members at risk for poor outcomes or inappropriate health care use.
Healthy First StepsTM (HFS) is a specialized case management program designed to provide assistance to all pregnant members, those experiencing an uncomplicated pregnancy, as well as additional medical, behavioral, and social risks. The goal is improving birth outcomes and lowering NICU admissions by managing prenatal and postpartum care needs of pregnant members. Care management staff are board-certified in maternal and neonatal medicine.
HFS-Maternal Care Model
The HFS-Maternal care model strives to:
- Increase early identification of expectant mothers and facilitate case management enrollment.
- Assess the member’s risk level and provide member-specific needs that support the care provider’s plan of care.
- Help members understand the importance of early and ongoing prenatal care and direct them to receiving it.
- Multidisciplinary support for pregnant women to overcome social and psychological barriers to prenatal care.
- Increase the member’s understanding of pregnancy and newborn care.
- Encourage pregnancy and lifestyle self-management and informed healthcare decision-making.
- Encourage appropriate pregnancy, postpartum and infant care provider visits.
- Foster a care provider-member collaboration before and after delivery as well as for non-emergent settings.
- Encourage members to stop smoking with our Quit for Life tobacco program.
- Help identify and build the mother’s support system including referrals to community resources and pregnancy support programs.
- Program staff act as a liaison between members, care providers, and United Healthcare for care coordination.
Tell UnitedHealthcare Community Plan when a member becomes pregnant. Faxing a Prenatal Risk Assessment form to the Healthy First Steps program at 877-353-6913 will initiate case management program outreach.
Improve asthma control and reduce allergies caused by dust or synthetic bedding. Controlling these issues can help to lower asthma-related hospitalizations and ER visits.
Hypoallergenic bedding is limited to individuals with asthma in case management. It is limited to $150 annually per member. The program requires prior authorization and documentation stating they have severe asthma. The member’s service coordinator will decide eligibility.
JOIN For Me is a childhood obesity program that helps create a healthier environment and behaviors in the home. Through a group intervention model, the child and caregiver learn healthy eating and exercise habits. JOIN For Me is for members ages 6-17. Call Provider Services for more information.
The KidsHealth website offers health and wellness resources to encourage healthy behaviors among children, young adults and their parents. These health care education resources include assistance for high-risk members managing such conditions as diabetes, asthma and stress. Links on the member website, myuhc.com, reveal videos and articles accessible through a computer, tablet or smartphone. KidsHealth is for members 20 years and younger.
We deliver this program to social worker and community partners. The focus is caregiver well-being. It provides mindfulness techniques to reduce burnout, raise performance and improve quality of care.
Apps are available at no charge to our members. They include:
- Health4Me enables users to review health benefits, access claims information and locate in-network providers.
- SMART Patient allows users to track important numbers such as blood pressure, record appointments, and record doctors’ orders. It also helps them view educational videos.
- OptumizeME allows users to set health and fitness goals, challenge other users to set their own goals, and post the results on Facebook.
- DocGPS provides mobile users the ability to search UnitedHealthcare Community Plan’s provider network and obtain travel directions to a care provider’s location. The app provides users with the ability to call a care provider by tapping on the search result.
- KidsHealth® answers health questions online through a partnership between UnitedHealthcare Community Plan and KidsHealth. Visit the website at UHCprovider.com/OHcommunityplan. Search by topic, read articles or watch videos. Teens can also find straight talk and personal stories. Younger children can learn through health quizzes, games and videos.
- Social Media provides assistance on Facebook, Twitter: @UHCPregnantCare (In Spanish: @UHCEmbarazada) by delivering health and wellness information relating to pregnancy, child birth and general health information applicable to pregnant women.
My Money Connect is a member incentive program designed to promote health, well-being, financial independence, as well as close gaps in care. The program provides a prepaid debit MasterCard® to members with an integrated wellness rewards program. It lets them earn incentives for actively improving their health. All members are eligible.
Some members require non-emergency transportation (NEMT) to and from services beyond what the state agency covers. NEMT provides crucial support in helping improve our members’ access to care. All members eligible for state-approved transportation services are qualified for this additional health benefit.
NEMT includes unlimited trips to and from WIC, methadone clinics, inpatient behavioral health and to the pharmacy immediately following a covered service appointment. To request and schedule rides, members call Medical Transportation Management (MTM) directly. If members need assistance in scheduling rides, the service coordinators, Member Services Advocates (MSAs) and the mobility manager can assist. Services may be scheduled up to 14 days in advance. Hotel stays will be paid for trips that require an overnight stay with prior approval for eligible members.
Urgent non-emergency trips, such as when a member is discharged from the hospital, may be made through the call center after 7 p.m. Central Time. Urgent calls are the ONLY calls taken in person by a reservation specialist after 7 p.m. Central Time. Schedule rides up to 30 days in advance.
For non-urgent appointments, members must call for transportation at least three days before their appointment.
Bus transportation will also be available if the member:
- Lives less than half a mile from a bus stop.
- Has an appointment less than half a mile from the bus stop.
NurseLine is available at no cost to our members 24 hours a day, seven days a week. Members may call NurseLine to ask if they need to go to the urgent care center, the ER or to schedule an appointment with their PCP. Our nurses also help educate members about staying healthy. Call 866-351-6827 to reach a nurse.
The Quit For Life® Program is the nation’s leading phone-based tobacco cessation program. It uses physical, psychological and behavioral strategies to help members take responsibility for and overcome their tobacco addiction. Using a mix of medication support, phone-based coaching, and web-based learning tools, the Quit For Life Program produces an average quit rate of 25.6 percent for a Medicaid population. It also has an 88 percent member satisfaction. Quit for Life is for members 18 years and older.
Our SUD (Substance Use Disorder) recovery coach works with members to develop coping skills. Skills include encouragement, safety and a sense of responsibility for their own recovery. This benefit also emphasizes support to those with a behavioral health diagnosis while working through SUD treatment and recovery.
Eligible members are identified through predictive modeling and claims data, a health risk assessment (HRA) or your referral. The program has no age limitation.
This program enrollment is offered to qualifying members so they may learn valuable skills about healthy eating and weight loss. Upon referral by your PCP, members will receive meeting vouchers to attend up to 10 meetings. Limited to members older than the age of 12.
This program provides federal grants for supplemental foods, health care referrals, and nutrition education for low-income pregnant, postpartum women. It also covers infants and children younger than age 5 who are at nutritional risk.
- Pregnant women, as soon as there is a positive pregnancy test
- Women who have been pregnant within the previous six months
- Breastfeeding women
- Children younger than 5 years
Referral – Make referrals as a part of the initial health assessment of a pregnant, breastfeeding, or postpartum woman and children younger than 5.
A current hemoglobin or hematocrit is required:
- Hemoglobin or hematocrit within 90 days of enrollment
- Hemoglobin or hematocrit within 90 days of each succeeding six-month certification except for a child whose blood value was within normal limits at the previous certification. For these children, the lab tests are required every 12 months
- For infants under 9 months of age, height/length and weight dated within 60 days of enrollment and with each six-month recertification