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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.

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

  • Claims Process Changes for UnitedHealthcare Community Plan and UnitedHealthcare Dual Complete

    Last Modified | 01.10.2019

    Starting Feb. 4, 2019, we’re changing how we process UnitedHealthcare Community Plan and UnitedHealthcare Dual Complete plan claims to help identify claims with incorrect codes before they’re processed. These new claim edits will allow you to resubmit claims more quickly and help reduce overpayment recovery requests.

    Learn More
  • Last Modified | 01.10.2019

    We hope you enjoy this edition of Practice Matters. In this issue, you can read about our quality management program, a summary of the 2018 medical record review, care coordination to address physical and mental health needs, and more.

    Learn More
  • Last Modified | 01.09.2019

    Practice Matters is a quarterly publication for physicians and other

    Learn More
  • Last Modified | 01.09.2019

    TennCare issued a policy (CON 09-001 (Rev. 5)), effective Sept. 21, 2018, to clarify the procedures for identifying and billing third parties for TennCare-covered services. TennCare removed prenatal care for pregnant women from the list of services that require the “pay and chase” approach. Instead, claims for these services will require the “cost avoidance” approach. This means that TennCare or its agents will hold payments to the care provider until the third party payer has paid its share.

    Learn More
  • Last Modified | 12.14.2018

    We’ve revised our payment policies for urgent care services for UnitedHealthcare Community Plan members. Effective April 1, 2019 for UnitedHealthcare Community Plan of Tennessee, we will no longer reimburse certain Healthcare Common Procedure Coding System (HCPCS) codes because they’re informational and indicate the type of reimbursement and the place of service instead of the specific service(s) provided. The affected HCPCS codes are: S9083: Global Fee Urgent Care Center and S9088: Services provided in an urgent care center

    Learn More
Claims Process Changes for UnitedHealthcare Community Plan and UnitedHealthcare Dual Complete

Last Modified | 01.10.2019

Starting Feb. 4, 2019, we’re changing how we process UnitedHealthcare Community Plan and UnitedHealthcare Dual Complete plan claims to help identify claims with incorrect codes before they’re processed. These new claim edits will allow you to resubmit claims more quickly and help reduce overpayment recovery requests.

Learn More
2018 4th Quarter Practice Matters - UnitedHealthcare Community Plan of Tennessee

Last Modified | 01.10.2019

We hope you enjoy this edition of Practice Matters. In this issue, you can read about our quality management program, a summary of the 2018 medical record review, care coordination to address physical and mental health needs, and more.

Learn More
2018 Tennessee Third Quarter Practice Matters

Last Modified | 01.09.2019

Practice Matters is a quarterly publication for physicians and other

Learn More
New TennCare Care Provider Responsibilities for Third Party Liability

Last Modified | 01.09.2019

TennCare issued a policy (CON 09-001 (Rev. 5)), effective Sept. 21, 2018, to clarify the procedures for identifying and billing third parties for TennCare-covered services. TennCare removed prenatal care for pregnant women from the list of services that require the “pay and chase” approach. Instead, claims for these services will require the “cost avoidance” approach. This means that TennCare or its agents will hold payments to the care provider until the third party payer has paid its share.

Learn More
Attention Urgent Care Centers: Payment Policy Change for Codes S9083 and S9088 - Effective April 1, 2019

Last Modified | 12.14.2018

We’ve revised our payment policies for urgent care services for UnitedHealthcare Community Plan members. Effective April 1, 2019 for UnitedHealthcare Community Plan of Tennessee, we will no longer reimburse certain Healthcare Common Procedure Coding System (HCPCS) codes because they’re informational and indicate the type of reimbursement and the place of service instead of the specific service(s) provided. The affected HCPCS codes are: S9083: Global Fee Urgent Care Center and S9088: Services provided in an urgent care center

Learn More
View More News

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.