Welcome to the Home for Care Provider Resources

For UnitedHealthcare Community Plan of Rhode Island

Welcome

For UnitedHealthcare Community Plan of Rhode Island

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.

Prior Authorization and Notification Resources

Current Policies and Clinical Guidelines

Provider Administrative Manual and Guides

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.

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. 

UnitedHealthcare Dual Complete® Special Needs Plan

UnitedHealthcare Dual Complete Special Needs Plans (SNP) offer benefits for people with both Medicare and Medicaid. These SNP plans provide benefits beyond Original Medicare, and may include transportation to medical appointments and vision exams. Members must have Medicaid to enroll.

Current News, Bulletins and Alerts

Medical Policy Documentation Requirement Updates Frequently Asked Questions - UnitedHealthcare Community Plans

Last Modified | 10.19.2020

We’ve refined medical policy documentation requirements and enhanced clinical coverage criteria for various procedures. This document contains information on effective dates by state and frequently asked questions.

Learn More
4th Quarter 2020 Preferred Drug List Updates- UnitedHealthcare Community Plans

Last Modified | 09.18.2020

UnitedHealthcare Community Plan’s Preferred Drug List (PDL) is updated quarterly by our Pharmacy and Therapeutics Committee. Please review the changes and update your references as necessary. The plan is for AZ, CA, HI, MD, NE, NV, NJ, NY, NY EPP, OH, PA CHIP, RI and VA.

Learn More
3rd Quarter 2020 Preferred Drug List Updates- UnitedHealthcare Community Plans

Last Modified | 06.15.2020

UnitedHealthcare Community Plan’s Preferred Drug List (PDL) is updated quarterly by our Pharmacy and Therapeutics Committee. Please review the changes and update your references as necessary. The plan is for AZ, CA, HI, MD, NE, NV, NJ, NY, NY EPP, OH, PA CHIP, RI and VA.

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.