Welcome to the Home for Care Provider Resources

For UnitedHealthcare Community Plan of Tennessee

Welcome

For UnitedHealthcare Community Plan of Tennessee

Welcome to the Home for Care Provider Resources

For UnitedHealthcare Community Plan of Tennessee

Welcome

For UnitedHealthcare Community Plan of Tennessee

UnitedHealthcare Community Plan of Tennessee 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

Behavioral Health

COVID-19 Resources for Providers

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Care Conductor

The best way for primary care professionals (PCPs) to manage Tennessee UnitedHealthcare Community Plan and UnitedHealthcare Dual Complete member care is using the Care Conductor tool on the UnitedHealthcare Provider Portal, which allows PCPs to:

  • View a member’s plan of care and health assessment
  • Enter plan notes and view notes history for some plans

For more information about Care Conductor please log in to the UnitedHealthcare Provider Portal.

CommunityCare

The best way for primary care professionals (PCPs) to view and export the full Tennessee UnitedHealthcare Community Plan and UnitedHealthcare Dual Complete member roster is using the CommunityCare feature on the UnitedHealthcare Provider Portal, which allows PCPs to:

  • See a complete list of all members, or members added in the last 30 days
  • Export the roster to Excel
  • Access information about patients admitted to or discharged from an inpatient facility
  • Access information about patients seen in an Emergency Department

For help using CommunityCare on the UnitedHealthcare Provider Portal, please see our CommunityCare Training. (Link to: https://chameleoncloud.io/review/5539-6217d56e4a9f5/prod)

If you’re new to the UnitedHealthcare Provider Portal, please visit UHCprovider.com/portal to register.

Good health outcomes start in the communities where your patients live. Starting October 2, we invite you to Connect with Us by taking the Providers CARE Survey.

By taking the survey, you’ll give us information about challenges your patients are facing in their communities. Our goal is to help you improve your patients’ health by:

C= Connecting them with community resources (like food pantries and housing help);

A= Acting for better health by teaching them about their care needs;

R=Reducing stigma by showing compassion to others and taking time to think about your actions and thoughts about yourself and others; and

E= Encouragement. Take the time to listen to your patients. Treating them with kindness and support can help them take the steps they need for better health and support them on their journey to their best life.

We are here to help you Connect your patients to CARE. The CARE survey will ask you about the social conditions impacting your patients and learning opportunities that can assist your practice team.

Thank you for caring about the health of your community.

We’re publishing this notification at TennCare’s request.

Provider Call Center

800-690-1606, available Monday-Friday from 8 a.m. – 6 p.m. Eastern Time.

Mailing Addresses 

Postal Mailing Address
UnitedHealthcare Community Plan
8 Cadillac Drive, Suite 100
Brentwood, TN 37027

Claims Address
UnitedHealthcare Community Plan
P.O. Box 5220
Kingston, NY 12402

Utilization Management Appeals Address
UnitedHealthcare Community Plan
P.O. Box 5220
Kingston, NY 12402

Part C Claims 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. 

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.

View TennCare's policy related to fraud and the Federal and State False Claims Act.

To report fraud, waste, or abuse concerns you can call 800-690-1606 (UnitedHealthcare Community Plan tipline) or 800-433-3982 (Division of TennCare & Office of Inspector General). Or, you can report fraud, waste and abuse concerns at the following link: EthicsPoint - UnitedHealthcare Fraud, Waste and Abuse Hotline.

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

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

Plan information is available for:

  • UnitedHealthcare Community Plan - TennCare

Member plan and benefit information can also be found atUHCCommunityPlan.com/TN and myuhc.com/communityplan.

Member Rights and Responsibilities

The UnitedHealthcare Community Plan Member Rights and Responsibilities can be found in the Provider Manual. Member Rights and Responsibilities are distributed to new members upon enrollment. On an annual basis, members are referred to their handbook to review their Member Rights and Responsibilities.

Need to make a change to your provider or facility directory information? 

TennCare

UnitedHealthcare Community Plan members can access and manage their TennCare benefit information online with TennCare Connect.

CoverKids

Effective Jan. 1, 2021 UnitedHealthcare Community Plan is participating in the CoverKids program.  

 

Reporting Fraud, Waste or Abuse to Us

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 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

Last Modified | 05.20.2022

TennCare is updating abortion, sterilization and hysterectomy forms and guidance effective July 1, 2021, for Tennessee Medicaid members.

Learn More

Last Modified | 05.04.2022

UnitedHealthcare Community Plan network care providers in Tennessee have access to AristaMD, a service that can help make specialty care appointments for members. This service can help save your staff time and help your patients get the specialty care they need.

Learn More

Last 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 More

Last Modified | 04.13.2022

The Centers for Medicare & Medicaid Services (CMS) has identified likely medically unnecessary use of drugs, such as antibiotics and antifungals1, that are being prescribed for topical use to be administered as a foot bath.

Learn More

Last Modified | 03.29.2022

As of Jan. 1, 2022, all TennCare CHOICES in Long Term Services (CHOICES) and Employment and Community First (ECF) providers must use the reportable event management (REM) process developed by the Department of Developmental Disabilities (DIDD) and TennCare.

Learn More
View More News

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.

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.