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.
800-600-9007, Monday-Friday, 8 a.m. – 5 p.m.
UnitedHealthcare Community Plan
2 Allegheny Center Suite 600
Pittsburgh, PA 15212
UnitedHealthcare Community Plan
PO Box 8207
Kingston, NY 12402-8207
UnitedHealthcare Community Plan
Attn: Grievances and Appeals
PO Box 31364
Salt Lake City, UT 84131-0364
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.
Learn how to join the Behavioral Health Network, review Community Plan Behavioral Health information, or submit demographic changes at Community Plan Behavioral Health.
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:
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:
Member plan and benefit information can also be found at UHCCommunityPlan.com/PA and myuhc.com/communityplan.
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:
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:
If you’re not familiar with our portal, go to UHCprovider.com/portal.
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.
Last Modified | 05.16.2022
The Pennsylvania Department of Human Services has updated its billing requirements for personal care services that are verified using an electronic visit verification (EVV) system. For dates of service starting May 1, 2022, health care professionals administering personal care services to UnitedHealthcare Community Plan members in their home must use HCPCS code T1019 when submitting claims and requesting prior authorization.
Learn MoreLast Modified | 05.16.2022
Health care professionals who wish to contract with UnitedHealthcare Community Plan may need a site visit as part of the credentialing process.
Learn MoreLast Modified | 04.29.2022
Effective Aug. 1, 2022, Optum will manage prior authorization requests for non-oncology injectable medications that are covered on the medical benefit for UnitedHealthcare Community Plans.
Learn MoreLast Modified | 04.01.2022
Topics in this article include: Reduced value for elevated lead level, Online submission for Obstetrical (OB) Needs Assessment forms, Tobacco treatment resources, Reportable conditions, and Reporting suspected abuse or neglect.
Learn MoreLast 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 MoreLast Modified | 05.16.2022
The Pennsylvania Department of Human Services has updated its billing requirements for personal care services that are verified using an electronic visit verification (EVV) system. For dates of service starting May 1, 2022, health care professionals administering personal care services to UnitedHealthcare Community Plan members in their home must use HCPCS code T1019 when submitting claims and requesting prior authorization.
Learn MoreLast Modified | 05.16.2022
Health care professionals who wish to contract with UnitedHealthcare Community Plan may need a site visit as part of the credentialing process.
Learn MoreLast Modified | 04.29.2022
Effective Aug. 1, 2022, Optum will manage prior authorization requests for non-oncology injectable medications that are covered on the medical benefit for UnitedHealthcare Community Plans.
Learn MoreLast Modified | 04.01.2022
Topics in this article include: Reduced value for elevated lead level, Online submission for Obstetrical (OB) Needs Assessment forms, Tobacco treatment resources, Reportable conditions, and Reporting suspected abuse or neglect.
Learn MoreLast 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 MoreHIPAA 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.
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.