Welcome to the New Home for Care Provider Resources

For UnitedHealthcare Community Plan of Tennessee

Welcome to the Home for Tennessee Community Plan Care Provider Resources

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.

Looking for ways to improve your patients’ outcomes?  Take the Providers CARE Survey and tell us about your patients.

The Providers CARE Survey helps us learn more about your patients’ needs and lets you share feedback about learning opportunities that may be useful for your practice team. You can fill out the survey by visiting https://www.tn.gov/tenncare/providers/literacy-communication-cultural-competency-and-disparities-in-health-care.html starting September 21. Your answers will not have your name on them and will be combined with information from other providers.

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= Empowering yourself and others. 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 supporting them on their journeys to better health

Improving health in Tennessee is a team effort.  Take the Providers CARE Survey and help us learn more about the needs of your patients and learning opportunities that can assist your practice.

Your answers will not have your name on them and will be combined with information from other providers.

Thank you for caring about the health of your community.

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

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/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? 

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.  

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Current News, Bulletins and Alerts

New NPI Requirement for Medicaid Plans - UnitedHealthcare Community Plan of Tennessee

Last Modified | 09.27.2018

Starting June 1, 2017, all claims submitted to UnitedHealthcare Community Plan must include the national provider identifier (NPI) number of the Tennessee Medicaid-enrolled ordering, prescribing or referring care provider. Claims submitted without the NPI number may be rejected.

Learn More
2018 2nd Quarter Practice Matters Physician Newsletter - UnitedHealthcare Community Plan of Tennessee

Last Modified | 09.14.2018

We hope you enjoy this edition of Practice Matters. In this issue, you can read about UHCCommunityPlan.com content transitioning to UHCprovider.com, appointment availability standards, preventive health screenings, and much more

Learn More
New Claim Denial Reason Codes Regarding Medicaid ID for UnitedHealthcare Community Plan of Tennessee

Last Modified | 09.12.2018

Starting Sept. 1, 2018, UnitedHealthcare Community Plan includes reasons that are more descriptive when a TennCare claim is denied because of an inactive or missing Tennessee Medicaid ID.

Learn More
2018 1st Quarter Practice Matters Physician Newsletter - UnitedHealthcare Community Plan of Tennessee

Last Modified | 08.29.2018

We hope you enjoy this edition of Practice Matters. In this issue, you can read about UHCCommunityPlan.com content transitioning to UHCprovider.com, enhancements to Electronic Data Interchange (EDI) claim status transactions, support for language services, and much more.

Learn More
New Edits for UnitedHealthcare Community Plan of Tennessee and UnitedHealthcare Dual Complete® Claims - Effective Sept. 1, 2018

Last Modified | 08.10.2018

Starting Sept. 1, 2018, we’re making a change to how we process UnitedHealthcare Community Plan and UnitedHealthcare Dual Complete plan claims. We’ll be using additional claim edits to help identify claims with incorrect codes before they’re processed. This will allow you to quickly resubmit claims and help us cut down on the overpayments we sometimes have to recover from care providers.

Learn More
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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.

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.