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UnitedHealthcare Community Plan of Texas Homepage

Severe Weather Alert for Areas of Texas


Severe weather has been reported in and around these Texas Medicaid service delivery areas: Dallas, Harris, Jefferson, MRSA Central, MRSA Northeast, and Tarrant. If you need assistance, please call 2-1-1. Designated shelter information can be found at redcross.org.

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.

STAR+PLUS: Service Delivery Area (SDA) Updates Effective Sept. 1, 2024

On September 1, 2024, the Texas Health and Human Services Commission (HHSC) will implement a new contract for STAR+PLUS. Some SDAs will change. 

Get the details

Providers in new SDAs should attend one of our in-person education events:
2024 STAR+PLUS expansion town hall meetings - Register today!

Prior Authorization and Notification Resources

Current Policies and Clinical Guidelines

Provider Administrative Manual and Guides

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Credentialing and Recredentialing FAQs for Health Care Professionals

For Credentialing and Attestation updates, please contact the National Credentialing Center at 1-877-842-3210.

How to - Credentialing and Recredentialing
Texas Facilities enrolled in Texas Medicaid can submit the Texas Facility Credentialing Application directly to Verisys, the Texas Association of Health Plans’ (TAHP’s) contracted Credentialing Verification Organization (CVO). The application can be submitted via one of the following methods: 

  • Upload to the secure document submission website using Access Code: aperture
  • Email to TAHPapps@verisys.com using the bar-coded letter at the top page of the PDF document
  • Fax to 866-293-0421 using the bar-coded letter as a cover sheet
  • Mail to:
    Verisys
    P.O. Box 221049
    Louisville, KY 40252-104

If you have trouble accessing or submitting the application, contact UnitedHealthcare Provider Services, toll-free, at 888-887-9003, 8 a.m. to 6 p.m. CT, Monday-Friday or the Verisys customer service team at 1-855-743-6161. Verisys may also contact you directly to initiate the facility credentialing process.

UnitedHealthcare Community Plan provides:

  • Cultural competency resources
  • Training - Cultural Competency and the American with Disabilities Act
  • Data attestation page to keep your provider profile current.
  • Language interpretation line with oral interpreter services 24 hours a day, 7 days a week in more than 240 non-English languages and hearing-impaired services are available. Members can call the phone number on their ID card.
  • Professional interpreters are available: 
    • During regular business hours, call Provider Services at 1-888-887-9003.
    • After hours, call Language Line Solutions at 1-877-261-6608. Enter the client ID 209677 (do not hit #). Press 1 for Spanish and 2 for all other languages.
  • I Speak language assistance card for providers helps identify preferred language and provides directions to arrange interpretation services for UnitedHealthcare members.
  • Materials for visually impaired, limited English-speaking members and those who speak languages other than English or Spanish. For more information, go to uhc.com > Language Assistance.

To Providers: Please update your enrollment and demographic information with TMHP (Texas Medicaid Healthcare Partnership). TMHP is HHSC’s provider enrollment administrator and serves as the authoritative source for HHSC Providers’ enrollment and demographic information. Once you update your enrollment and demographic information with TMHP, your data will be reconciled with the demographic information on file with the MCOs.

To make updates to your current enrollment (e.g., new practice locations or change of ownership updates), please access the web page titled “Provider Enrollment on the Portal - A Step-by-Step Guide” at the following URL: Provider Enrollment | TMHP.

For instructions on how to make demographic changes to your current enrollment, please access the web page titled “Provider Enrollment and Management System (PEMS): A Step-by-Step Guide” at the following URL: Provider Enrollment and Management System (PEMS) | TMHP.

Otherwise, you can contact TMHP directly at 800-925-9126 for assistance. 

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/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/communityplan.

If our members need help with finding a provider, specialty consultation, or referral, or they have a question about their health plan, please have them call us. 

Our Member Services in Texas can be reached toll-free at 1-888-887-9003, TDD/TTY: 7-1-1, 8:00 a.m.-8:00 p.m., Monday-Friday.

 

Nurse Hotlines - Available 24 hours a day, 7 days a week:

  • CHIP - 1-844-644-7429 
  • MMP - 1-844-901-3680
  • STAR - 1-866-505-0489
  • STAR Kids - 1-844-901-3680
  • STAR+PLUS - 1-833-756-8592

The primary function of the Network Provider Advisory Group (NPAG) is to discuss and advise on the dynamics of managed care in the specified Service Delivery Area, which is represented. The committee will also provide a stabilizing influence so organizational concepts and directions are established and maintained. Members of the Advisory Group will help identify issues, so that UnitedHealthcare Community Plan of Texas can adequately address them. In practice, these responsibilities will be carried out by performing the following functions: 

  • Participate in face-to-face, WebEx meetings and conference calls
  • Monitor and review pertinent documents at regular Advisory Group meetings
  • Advise when emergent issues force changes to be considered and ensure that scope aligns with the agreed requirements 
  • Resolve conflicts and disputes, reconciling differences of opinion and approach
  • Advise on prioritization of objectives and outcomes as identified 

The NPAG will meet quarterly in a teleconference/WebEx format. The schedule is dictated by state fiscal year.

If a provider is interested in joining, please send an email to uhc_cp_prov_relations@uhc.com.

What are NEMT services?

NEMT services provide transportation to covered health care services for patients who have no other means of transportation. Such transportation includes rides to the doctor, dentist, hospital, pharmacy and other places an individual receives Medicaid services. NEMT services do NOT include ambulance trips or transportation while receiving LTSS.

Contact Information

If you have a member you think would benefit from receiving NEMT services, please refer them to us for information. They can call customer service at 1-888-887-9003. For inquiry follow-ups that surpass 3 days or escalation requests, send an email to Tx.Transportation@modivcare.com.

Member Responsibilities

When using non-emergent medical transportation (NEMT) services, you have the responsibilities to:

  • Provide the information requested by the person arranging or verifying your transportation.
  • Follow all rules and regulations affecting your NEMT services. 
  • Return unused advanced funds. You must provide proof that you kept your medical appointment prior to receiving future advanced funds.
  • Do not verbally, sexually or physically abuse or harass anyone while requesting or receiving NEMT services. 
  • You must not lose bus tickets or tokens and must return any bus tickets or tokens that you do not use. You must use the bus tickets or tokens only to go to your medical appointment. 
  • Only use NEMT Services to travel to and from your medical appointments.
  • Contact the person who helped you arrange your transportation as soon as possible if something changes and you no longer need the service.

Note: For inquiry follow-ups that surpass 3 days or escalation requests, send an email to Tx.Transportation@modivcare.com.

UnitedHealthcare Community Plan contracts with nursing facilities for network participation.

Nursing Facility Providers of Long-Term Care who need to reach a provider relations advocate can:

For additional assistance, contact:
Sandi Howard, NSLS, BSHA, MHA
Director of Medicaid Provider Engagement
Office 1-952-202-3559
Fax 1-855-529-4794
sandi.howard@optum.com

CommunityCare

The best way for primary care providers (PCPs) to view and export the full member roster is using the CommunityCare feature on the UnitedHealthcare Provider Portal, which allows you to:  

  • Identify Medicaid recipients who need to have their Medicaid recertification completed and approved by the state in order to remain eligible to receive Medicaid benefits
  • See a complete list of all members, or just members added in the last 30 days
  • Export the roster to Microsoft Excel
  • View most Medicaid and Medicare Special Needs Plans (SNP) members’ plans of care and health assessments
  • Enter plan notes and view notes history (for some plans)
  • Obtain HEDIS information for your member population
  • Access information about members admitted to or discharged from an inpatient facility
  • Access information about members seen in an emergency department

For help using CommunityCare feature on the UnitedHealthcare Provider Portal, please see our Quick Reference Guide. If you’re not familiar with UnitedHealthcare Provider Portal, go to UHCprovider.com/portal.

Complaints

File verbally by phone:

  • Call Customer Service at 1-888-887-9003

File by fax:

The following complaint form can be sent by fax:

File by mail:

  • UnitedHealthcare Community Plan
    PO Box 31364
    Salt Lake City, UT 84131-0364

The HHSC mailbox for provider complaints: HPM_Complaints@hhsc.state.tx.us.

Claims Reconsiderations and Appeals

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

  • An appeal or reconsideration can be sent to by mail to:

UnitedHealthcare Community Plan
Attn:  Complaint and Appeals Dept.
PO Box 31364
Salt Lake City, UT 84131-0364

 

The way you submit a referral request depends on the member’s plan. You can use Eligibility and Benefits 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.

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.