Welcome to the New Home for Care Provider Resources

For UnitedHealthcare Community Plan of Texas

Welcome to the Home for Texas Community Plan 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, 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 Administrative Guide.  

Learn about requirements for joining our network

Overview

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.

For information on how to file a complaint or appeal, please visit the Contact Us page. 

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

Medicaid Enrollment Deadline Extended to October 31, 2018 for Long-Term Services and Supports Providers

Last Modified | 09.18.2018

The enrollment deadline has been extended to October 31, 2018, for LTSS providers serving managed care members (MCO) that are required to enroll through the Medicaid MCO LTSS provider enrollment process.

Learn More
Texas Practice Matters Summer 2018

Last Modified | 09.11.2018

We hope you enjoy the summer edition of Practice Matters. In this issue, you can read about UHCCommunityPlan.com care provider content transitioning to UHCprovider.com, billing tips, UHC On Air, and much more.

Learn More
Respite Prior Authorization Requests for STAR+PLUS Waiver Members for UnitedHealthcare Community Plan of Texas

Last Modified | 09.04.2018

We’ve changed the way we handle prior authorization requests for in-home respite hours for UnitedHealthcare Community Plan STAR+PLUS Waiver members. Respite hours will now be authorized for the length of the member’s individualized service plan. This will be done during the member’s annual assessment.

Learn More
EVV Alert: Notice of Billing Policy Changes to Providers Required To Use EVV

Last Modified | 09.04.2018

Based on recommendations from the Health and Human Services Commission Office of Inspector General in the May 2018 Electronic Visit Verification Inspection Report, HHSC will be implementing billing policy changes starting in state fiscal year 2020.

Learn More
EVV Alert: Electronic Visit Verification Providers Transitioning To DataLogic

Last Modified | 09.04.2018

By Sept. 30, 2018, all providers transitioning to DataLogic Vesta EVV from MEDsys VinCENT must have completed their transition. A provider’s official transition date is the date the provider agency will begin using the Vesta EVV system.

Learn More
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Decorative: UHC on Air text above stylized monitor.

UHC On Air gives you in-depth program information and meaningful updates from UnitedHealthcare 24/7and from any device.

Learn More

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.