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For UnitedHealthcare Community Plan of Texas

Welcome to the Home for Community Plan of Texas Care Provider Resources

For UnitedHealthcare Community Plan of Texas

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UnitedHealthcare Community Plan of Texas 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.

For Credentialing and Attestation updates, please 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/TX for current member plan information including sample member ID cards, provider directories, dental plans, vision plans and more.

Plan information is available for:

  • Care Improvement Plus Dual Advantage (Regional PPO SNP)
  • Texas STAR
  • Texas STAR Kids
  • Texas STAR+PLUS
  • UnitedHealthcare Community Plan - Children's Health Insurance Program (CHIP)
  • UnitedHealthcare Connected (Medicare-Medicaid Plan)
  • UnitedHealthcare Dual Complete® (HMO SNP) and UnitedHealthcare Dual Complete® (HMO SNP)
  • UnitedHealthcare Dual Complete® (PPO SNP) 

Information available includes:

  • Current plan names
  • Plan details
  • Overvew of eligibility information
  • Member contact information
  • Member Handbook, which includes great information, including:
    • Member rights and responsibilities
    • Member complaints process
    • Member appeals process 

Member plan and benefit information can also be found at UHCCommunityPlan.com/TX and myuhc.com.

Complaint

A complaint can be sent to:

UnitedHealthcare Community Plan

PO Box 31364

Salt Lake City, UT 84131-0364

Complaint form is located at provider forms.

Claims Reconsiderations and Appeals

A Claims Reconsideration can be completed online faxed.  For more information, see UHCProvider.com > Claims & Payments > Submit a Corrected Claim, Claim Reconsideration/Begin Appeals Process.

An appeal can be sent to:

UnitedHealthcare Community Plan

 Attn:  Complaint and Appeals Dept.

 PO Box 31364

 Salt Lake City, UT 84131-0364

Appeals can be written in a letter format

The way you submit a referral request depends on the member’s plan. You can use eligibilityLink to determine the right tool to use for your submission.

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.  

Reporting Fraud, Waste or Abuse to the State of Texas

You can report suspected fraud, waste, or abuse by recipients or providers in Texas health and human services programs online or by calling their toll-free fraud hotline. The Texas health and human services system includes:

  • Medicaid
  • The Supplemental Nutrition Assistance Program (SNAP, formerly known as Food Stamps)
  • Temporary Assistance for Needy Families (TANF)
  • Women, Infants, and Children (WIC) program
  • The Children's Health Insurance Program (CHIP)

Learn more about how to make a report to Texas Health Human Services.

Logos: CHIP, STAR, STAR Kids, STAR Plus and Texas HHS

Current News, Alerts and Messages from Texas HHSC

Claims Reconsiderations and Appeals

Last Modified | 04.15.2019

You have options to dispute a claim denial when necessary for services denied in whole or in part that were provided to our members in the following Texas programs: Medicaid, Children’s Health Insurance Program (CHIP) and UnitedHealthcare Connected® (Medicare-Medicaid Plan). We’re highlighting when and how you can submit a claim reconsideration or an appeal.

Learn More
Provider Alert: Update to UnitedHealthcare Dual Complete Claims Processing for Texas

Last Modified | 04.12.2019

We recently learned our system has been incorrectly processing claims when a UnitedHealthcare member has both UnitedHealthcare Dual Complete (Medicare) and STAR+PLUS (Medicaid) coverage. We are working to assess all impacted claims. When Medicare is the primary payer and Medicaid is the secondary payer, this is known as a crossover claim.

Learn More
HHSC Alert: Billing Policy Changes for Providers Required to Use EVV: Update to March 15, 2019 Alert

Last Modified | 04.08.2019

To confirm that a service visit occurred before payment of a claim, EVV relevant claims will be subject to the EVV claims matching process beginning Sept. 1, 2019.

Learn More
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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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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.