UnitedHealthcare Community Plan of Tennessee Homepage

Through an online portal, axialPRACTICE gives you access to resources that help monitor a member’s overall opioid-related risks, including the member’s medication and treatment history from other care providers, information to help you treat common pain complaints, support for managing complex cases, and the opportunity to consult directly with licensed axialHealthcare pharmacists when developing care plans for members. 

Login to the axialPRACTICE Provider Validation Tool using your Optum ID. You will need to fill out a short form with your Tax ID Number (TIN) and National Provider Identifier (NPI) number.

If you’d like to provide evidence-based care for your patients diagnosed with Opioid Use Disorder (OUD), or to identify those at risk, we’re pleased to announce a new Project ECHO training series on Buprenorphine-focused Medication Assisted Treatment (BMAT) starts August 7, 2019.

The series is a collaboration between East Tennessee State University, UnitedHealthcare Community Plan, Amerigroup and BlueCross BlueShield of Tennessee. BMAT Project ECHO aims to equip care providers with the latest clinical information and best practices so you can help improve access for patients suffering from OUD. The six-week online training consists of brief educational sessions followed by case presentations. The training session is available starting August 7, 2019, and training will be available through July 2020.

BMAT Project ECHO is an interactive experience offering free:

• Training and support on how to best deliver BMAT services
• Weekly informative sessions with addiction/OUD subject matter experts
• Education credit including continuing medical education (CME) credits

After participating in the BMAT Project ECHO series, you should be able to:

• Identify key components of the MAT model
• Explain the benefits of providing MAT
• Know how to use the interdisciplinary approach that best fits their practice

To participate in an upcoming clinical tele-education session, all you need is a computer with a camera and microphone to connect using the free, online video conferencing platform Zoom. You don’t need a Zoom account to participate.

To learn more and register for an upcoming training, visit etsu.edu/etsubmatecho.

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.

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.

Helpful Resources

• Medicaid Managed Care Rule Overview Presentation
• Medicaid Managed Care Rule Frequently Asked Questions

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.

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.

Search for a Provider

• UnitedHealthcare Community Plan of Tennessee
• UnitedHealthcare Dual Complete® (HMO SNP) and UnitedHealthcare Dual Complete® ONE (HMO SNP)
  

Referral Provider Listings by Region

• Referral Provider Listing - East (Last Modified 06.13.2019)
• Referral Provider Listing - Middle (Last Modified 06.13.2019)
  
• Referral Provider Listing - West (Last Modified 06.13.2019)
  
• Referral Provider Listing - Home and Community Based Services Providers (Last Modified 06.13.2019)
  

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

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.  

Resources

• TennCare Kids Preventive Visits Reimbursement Reference Guide
• TennCare Kids / EPSDT Coding Program Overview
• TennCare Kids / EPSDT General Information
• TennCare Kids Website
  
• Tennessee Chapter of the American Association of Pediatrics (TNAAP)
  

Immunization Schedules

• Child / Adolescent
  
• Adult Schedule