Welcome to the Home for Care Provider Resources

For UnitedHealthcare Community Plan of Pennsylvania


For UnitedHealthcare Community Plan of Pennsylvania

Welcome to the Home for Care Provider Resources

For UnitedHealthcare Community Plan of Pennsylvania


For UnitedHealthcare Community Plan of Pennsylvania

UnitedHealthcare Community Plan of Pennsylvania Homepage


Effective January 1, 2020 we are transitioning to a statewide Preferred Drug List (PDL). Please see the DHS state website for additional information - https://papdl.com/preferred-drug-list.

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

Provider Call Center

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

Postal Mailing Address

UnitedHealthcare Community Plan
2 Allegheny Center Suite 600
Pittsburgh, PA 15212

Claims Mailing Address

UnitedHealthcare Community Plan
PO Box 8207
Kingston, NY 12402-8207

Utilization Management Appeals Address 

UnitedHealthcare Community Plan
Attn: Grievances and Appeals
PO Box 31364
Salt Lake City, UT 84131-0364

Claims Appeals Mailing Address

Part C Appeals and Grievance Department
UnitedHealthcare Community Plan
Attn: Complaint and Appeals Department
P.O. Box 31364
Salt Lake City, UT 84131-0364
Part D Appeals and Grievance Department
Attn: CA124-0197
P.O. Box 6106
Cypress, CA 90630-9948

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


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/PA for current member plan information including sample member ID cards, provider directories, dental plans, vision plans and more.

Plan information is available for:

  • Pennsylvania UnitedHealthcare Community Plan for Families
  • Pennsylvania UnitedHealthcare Community Plan for Kids

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

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

Forms for Medical Assistance members are available from the Pennsylvania Department of Human Services website. Most forms are available in both English and Spanish. Available forms include:

  • Abortion Consent Form
  • Eligibility Determination Form
  • Hysterectomy Consent Form
  • Medical Assistance Provider Order Form
  • Medical Evaluation Plan of Care Form
  • Newborn Eligibility Form
  • Obstetrical Needs Assessment Form
  • Outpatient Services Authorization Request Form
  • Recipient Statement Forms
  • Service Coordination Plan
  • Sterilization Consent Form

The best way for primary care providers (PCPs) to view and export the full member roster is using the CommunityCare tool, which allows you to:  

  • See a complete list of all members, or just members added in the last 30 days
  • Export the roster to Excel
  • View most Medicaid and Medicare SNP members’ plans of care and health assessments
  • Enter plan notes and view notes history (for some plans)
  • Obtain HEDIS information for your member population
  • Access information about members admitted to or discharged from an inpatient facility
  • Access information about members seen in an Emergency Department

If you’re not familiar with our portal, go to UHCprovider.com/portal.

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 Community Plan offers a Special Needs Unit (SNU) to help members who have special needs because of on-going physical, developmental, emotional or behavioral conditions.

If you have a UnitedHealthcare Community Plan patient who has a special need, please consider calling or having your patient call the Special Needs Unit at 877-844-8844 or Member Services at 800-414-9025. 

Current News, Bulletins and Alerts

Practice Matters: Family Visiting program

Last Modified | 07.30.2021

The Family Visiting program (FVP) is designed to support families with risk factors that could impede the development of strong family relationships.

Learn More
Practice Matters: Language services

Last Modified | 07.30.2021

UnitedHealthcare Community Plan of Pennsylvania can help find language services for your patients who are our members. Services are available by phone and in person for members who are deaf, hard of hearing or have language barriers.

Learn More
Practice Matters: Early and Periodic Screening, Diagnosis and Treatment

Last Modified | 07.30.2021

Early and Periodic Screening, Diagnosis and Treatment UnitedHealthcare Community Plan of Pennsylvania

Learn More
Medicaid: Take 5 minutes to share your point of view

Last Modified | 07.09.2021

UnitedHealthcare Community Plan network providers will have the opportunity to share their feedback about their experience working with us by taking our Physician Satisfaction Survey. This survey applies to physicians who participate in Medicaid.

Learn More
Find COVID-19 vaccine availability for your state or territory

Last Modified | 05.21.2021

Use this list of local health departments to learn about availability in your area. Availability may vary by location and time. We encourage you to check back often as information becomes more available.

Learn More
View More News

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.


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.