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
COVID-19 Resources for Providers
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
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Update to Procedure to Modifier Policy for “Always Therapy” Codes – Effective July 1, 2019 for UnitedHealthcare Community Plan of CA, HI, FL, LA, MD, MA, MI, MS, NE, NJ, NY, OH, PA, RI, WA, WI, VA
Last Modified | 05.14.2020
UnitedHealthcare Community Plan is updating its Procedure to Modifier Policy for claims for dates of service on or after July 1, 2019. Physical therapy (GP), occupational therapy (GO) or speech-language pathology (GN) modifiers will be required on “Always Therapy” codes to align with the Centers for Medicare & Medicaid Services (CMS).
Learn More -
DUR Educational Newsletter: Safety in Respiratory Therapy - UnitedHealthcare Community Plan
Last Modified | 04.24.2020
The National Asthma Education and Prevention Program (NAEPP) published guidelines for the treatment of asthma in2007.¹ The guidelines outline goals of therapy that include the prevention of recurrent exacerbation and need for emergency department or hospital care, the prevention of reduced lung growth in children or loss of lung function in adults, and the optimization of pharmacotherapy with minimal or no adverse effects.
Learn More -
Update: Nonphysician Health Care Professionals Billing Evaluation and Management Codes Policy, Professional - Effective May 31, 2020 - UnitedHealthcare Community Plan of NY, RI
Last Modified | 03.02.2020
Effective with dates of process on or after May 31, 2020 in alignment with and CPT ®, reimbursement for Evaluation and Management (E/M) codes (99201-99499) submitted by an audiologist will be denied.
Learn More
Update to Procedure to Modifier Policy for “Always Therapy” Codes – Effective July 1, 2019 for UnitedHealthcare Community Plan of CA, HI, FL, LA, MD, MA, MI, MS, NE, NJ, NY, OH, PA, RI, WA, WI, VA
Last Modified | 05.14.2020
UnitedHealthcare Community Plan is updating its Procedure to Modifier Policy for claims for dates of service on or after July 1, 2019. Physical therapy (GP), occupational therapy (GO) or speech-language pathology (GN) modifiers will be required on “Always Therapy” codes to align with the Centers for Medicare & Medicaid Services (CMS).
Learn MoreDUR Educational Newsletter: Safety in Respiratory Therapy - UnitedHealthcare Community Plan
Last Modified | 04.24.2020
The National Asthma Education and Prevention Program (NAEPP) published guidelines for the treatment of asthma in2007.¹ The guidelines outline goals of therapy that include the prevention of recurrent exacerbation and need for emergency department or hospital care, the prevention of reduced lung growth in children or loss of lung function in adults, and the optimization of pharmacotherapy with minimal or no adverse effects.
Learn MoreUpdate: Nonphysician Health Care Professionals Billing Evaluation and Management Codes Policy, Professional - Effective May 31, 2020 - UnitedHealthcare Community Plan of NY, RI
Last Modified | 03.02.2020
Effective with dates of process on or after May 31, 2020 in alignment with and CPT ®, reimbursement for Evaluation and Management (E/M) codes (99201-99499) submitted by an audiologist will be denied.
Learn MoreHEDIS Medical Record Collection
- HEDIS® Medical Record Collection - Frequently Asked Questions
- HEDIS® Medical Record Collection - Overview
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.