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For UnitedHealthcare Community Plan of Pennsylvania

Welcome to the Home for Pennsylvania Community Plan Care Provider Resources

For UnitedHealthcare Community Plan of Pennsylvania

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UnitedHealthcare Community Plan of Pennsylvania 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.

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

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.

Helpful Resources

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.

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

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

Summer/Fall 2018 Practice Matters Newsletter - UnitedHealthcare Community Plan of Pennsylvania

Last Modified | 11.06.2018

We hope you enjoy this edition of Practice Matters. In this issue, you can read about the Qualified Awards Program, on-demand broadcasts on UHC On Air, the role of dentists in managing opioids, and much more.

Learn More
Coding For Social Determinants of Health

Last Modified | 11.01.2018

Social determinants of health are societal and environmental conditions such as food, housing, transportation, education, experiences, social support and employment that can affect a person’s health. Numerous studies have demonstrated a link between economic status, social factors and physical environment as key influencers in health outcomes.

Learn More
Validated Screening Tools for Developmental Delays and Autism Spectrum Disorders

Last Modified | 10.08.2018

Developmental and autistic screening tests are used to detect potential of early disease, health disorders or risk factors in those who don't have any symptom of the disease. The main goal of screening tests is the early detection of the disease to help treat the disease effectively and reduce the possible risk. The following chart shows various developmental and autistic screening tools available to care providers for Pennsylvania Medical Assistance members.

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Requirements and Resources for Structured Screening for Developmental Delays and Autism Spectrum Disorder for Medical Assistance Recipients

Last Modified | 10.05.2018

We’ve recently become aware that not all UnitedHealthcare Community Plan (Medicaid) care providers are screening for developmental delays and autism spectrum disorder, as required by the Department of Human Services (DHS). These screenings are important because they can help your young patients get the specialized care they need to thrive as they grow. Because of their importance, these requirements are also integrated into Pennsylvania's Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program.

Learn More
Guide to UnitedHealthcare Community Plan of Pennsylvania Clinical Programs - UnitedHealthcare Community Plan of Pennsylvania

Last Modified | 06.29.2018

At UnitedHealthcare Community Plan, we work with our network physicians, health care providers and local communities to help members live healthier lives.

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.