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.
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:
For more information about Care Conductor please log in to the UnitedHealthcare Provider Portal.
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:
For help using CommunityCare on the UnitedHealthcare Provider Portal, please see our CommunityCare Training. (Link to: https://chameleoncloud.io/review/5539-6217d56e4a9f5/prod)
If you’re new to the UnitedHealthcare Provider Portal, please visit UHCprovider.com/portal to register.
800-690-1606, available Monday-Friday from 8 a.m. – 6 p.m. Eastern Time.
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 questions for the Applied Behavior Analysis (ABA) Utilization Management Team:
For Credentialing and Attestation updates, contact the National Credentialing Center at 1-877-842-3210.
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.
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.
Learn how to join the Behavioral Health Network, review Community Plan Behavioral Health information, or submit demographic changes at Community Plan Behavioral Health.
Access our FAQ on DIDD program integration TennCare and Department of Intellectual/Development Disabilities (DIDD) Program Integration.
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:
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:
Member plan and benefit information can also be found atUHCCommunityPlan.com/TN and myuhc.com/communityplan.
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.
UnitedHealthcare Community Plan members can access and manage their TennCare benefit information online with TennCare Connect.
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 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.
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.
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.