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

340B Billing

• Drugs billed to the medical benefit for applicable 340B claims-
  • Modifier: UD
  • Description: Medicaid level of care 13, as defined by each state
• Drugs billed to the pharmacy benefit for applicable 340B claims-
  • NCPDP field 409-D9: Ingredient Cost Submitted = 340B Acquisition Cost with the associated value 08 in NCPDP field 423-DN: Cost Basis
  • NCPDP field 420-DK: Submission Clarification Code = 20

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/communityplan.

To help you more easily deliver care to UnitedHealthcare Community Plan of Rhode Island members, we’re temporarily removing the referral requirement for members who see in-network specialists. For dates of service starting April 21, 2020, and extending until further notice, we won’t deny claims for covered services because there’s no referral in the system.

This change to the referral requirements doesn’t affect existing prior authorization and notification requirements.

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.