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.
Are you a member looking for health plan or provider information?
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COVID-19 vaccine information and resources
- Get the latest COVID-19 vaccine information and FAQs from the TN Department of Health.
- Interested in becoming a COVID-19 vaccinating provider? Learn more on their website.
- TN Dept of Health: COVID-19 Vaccine Information for Healthcare Providers
- TennCare: COVID-19 Prevention and Response Guidance
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.
If you’re new to the UnitedHealthcare Provider Portal, please visit UHCprovider.com/portal to register.
Intelligence Hub
The UnitedHealthcare Intelligence Hub is designed to provide access to actionable data through robust business intelligence reporting for providers in Tennessee’s Patient Centered Medical Home (PCMH), Tennessee Health Link (THL), Episodes of Care (EOC) and TennStar programs. Data dashboards will include leading indicators and trends that impact provider performance and incentives.
Dashboard data to include:
- Assigned member attribution
- Clinical outcomes
- ADT
- Claims
- Program HEDIS outcomes
For more information about the Intelligence Hub, please contact your PCMH, THL, EOC or TennStar representative.
Intelligence Hub: https://vbpintelligencehub.com
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
10 Cadillac Drive, Suite 200
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 questions for the Applied Behavior Analysis (ABA) Utilization Management Team:
- Call the Customer Service number on the back of the Member ID card or forward your questions to: tn_medicaid_aba@uhc.com
- Request to Join the Network
- Or, contact Provider Relations and Network Strategy, TN – uhccp_bhnetwork@uhc.com
For questions about Credentialing and Attestation updates, connect with us through chat 24/7 in the UnitedHealthcare Provider Portal.
Connect with us through chat 24/7 in the UnitedHealthcare Provider Portal. For additional contact information, visit our Contact us page.
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 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.
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
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.
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.
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.
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.
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.