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For UnitedHealthcare Community Plan of Rhode Island

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For UnitedHealthcare Community Plan of Rhode Island

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UnitedHealthcare Community Plan of Rhode Island 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.

For Credentialing and Attestation updates, contact the National Credentialing Center at 1-877-842-3210.

Provider Call Center

877-842-3210 - 24 hours a day, 7 days a week and holidays

Mailing Address

UnitedHealthcare Community Plan
Attn: Medicaid Program
475 Kilvert Street
Warwick, RI 02886

Utilization Management Appeals Address

UnitedHealthcare Community Plan
P.O. Box 31364
Salt Lake City, Utah 84131

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

Plan information is available for:

  • Rhode Island Children with Special Health Care Needs
  • Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
  • Rhode Island UnitedHealthcare Rhody Health Partners
  • Rhode Island UnitedHealthcare RIte Care

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

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, UnitedHealthcare works to detect, correct and prevent fraud , waste  and abuse  in the health care system.

Call us at 1-844-359-7736 or at uhc.com/fraud to report any issues or concerns. 

Current News, Bulletins and Alerts

  • Cedar Family Services Is Now Covered Under UnitedHealthcare Community Plan

    Last Modified | 10.26.2018

    United Healthcare Community Plan in Rhode Island started covering Cedar Family Services for children and youth with special health care needs on Oct. 1, 2018. These services were previously covered through the Rhode Island Executive Office of Health and Human Services.

    Learn More
  • Last Modified | 08.21.2018

    Practice Matters is a quarterly publication for physicians and other health care professionals and facilities in the UnitedHealthcare network.

    Learn More
  • Last Modified | 07.03.2018

    Starting Oct. 1, 2018, UnitedHealthcare Community Plan will change the existing Obstetrical Ultrasound Policy to further align with Medicaid guidelines. Medicaid does not consider ultrasounds to be medically necessary if they are done only to determine the fetal sex or provide parents with a photograph of the fetus. A detailed ultrasound fetal anatomic examination is also considered medically unnecessary for a routine screening of a normal pregnancy

    Learn More
  • Last Modified | 06.28.2018

    We hope you enjoy this edition of Practice Matters. In this issue, you can read about prevention efforts for HIV, STDs and Hepatitis C, CAHPS survey results, treatment for members with substance abuse disorder, and much more.

    Learn More
  • Last Modified | 06.28.2018

    We hope you enjoy this edition of Practice Matters. In this issue, you can read about our quality improvement program, coordination of care between PCPs and specialists, appointment availability standards, and much more.

    Learn More
Cedar Family Services Is Now Covered Under UnitedHealthcare Community Plan

Last Modified | 10.26.2018

United Healthcare Community Plan in Rhode Island started covering Cedar Family Services for children and youth with special health care needs on Oct. 1, 2018. These services were previously covered through the Rhode Island Executive Office of Health and Human Services.

Learn More
Rhode Island Spring/Summer Practice Matters 2018.pdf

Last Modified | 08.21.2018

Practice Matters is a quarterly publication for physicians and other health care professionals and facilities in the UnitedHealthcare network.

Learn More
Obstetrical Ultrasound Reimbursement Policy Update: Quantity Limitations

Last Modified | 07.03.2018

Starting Oct. 1, 2018, UnitedHealthcare Community Plan will change the existing Obstetrical Ultrasound Policy to further align with Medicaid guidelines. Medicaid does not consider ultrasounds to be medically necessary if they are done only to determine the fetal sex or provide parents with a photograph of the fetus. A detailed ultrasound fetal anatomic examination is also considered medically unnecessary for a routine screening of a normal pregnancy

Learn More
Fall/Winter 2017 Practice Matters Newsletter

Last Modified | 06.28.2018

We hope you enjoy this edition of Practice Matters. In this issue, you can read about prevention efforts for HIV, STDs and Hepatitis C, CAHPS survey results, treatment for members with substance abuse disorder, and much more.

Learn More
Summer 2017 Practice Matters Newsletter

Last Modified | 06.28.2018

We hope you enjoy this edition of Practice Matters. In this issue, you can read about our quality improvement program, coordination of care between PCPs and specialists, appointment availability standards, and much more.

Learn More
View More News

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.