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For UnitedHealthcare Community Plan of Tennessee

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For UnitedHealthcare Community Plan of Tennessee

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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.

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.

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.

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

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. 

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

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.  

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

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.

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UHC On Air gives you in-depth program information and meaningful updates from UnitedHealthcare 24/7and from any device.

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Current News, Bulletins and Alerts

2019 1st Quarter Practice Matters for UnitedHealthcare Community Plan of Tennessee

Last Modified | 05.09.2019

Practice Matters is a quarterly publication for physicians and other health care professionals and facilities in the UnitedHealthcare network.

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We’re Retiring the Fax Number You Use for Medical Prior Authorization Requests

Last Modified | 05.06.2019

On May 6, 2019, the UnitedHealthcare Community Plan of Tennessee fax number, 800-743-6829, you use for medical prior authorization requests will retire. Start using the Prior Authorization and Notification tool today to submit your requests and see how our online tools are better than faxing.

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Update to Procedure to Modifier Policy for “Always Therapy” Codes – Effective July 1, 2019 for UnitedHealthcare Community Plan of Tennessee

Last Modified | 05.02.2019

UnitedHealthcare Community Plan is updating the Procedure to Modifier Policy for claims with 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).

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New Discarded Drugs and Biological Policy - UnitedHealthcare Community Plan of Tennessee

Last Modified | 03.27.2019

UnitedHealthcare Community Plan is implementing a new Discarded Drugs and Biological Policy that applies to claims with dates of service on or after April 1, 2019, for members in Tennessee.

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TennCare Prescription Utilization Reviews - UnitedHealthcare Community Plan of Tennessee

Last Modified | 02.22.2019

Any care provider registered with TennCare cannot accept cash payment from a TennCare enrollee beyond the authorized co-pay amounts.

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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.

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.