Welcome to the Home for Care Provider Resources

For UnitedHealthcare Community Plan of Washington

Welcome

For UnitedHealthcare Community Plan of Washington

UnitedHealthcare Community Plan of Washington 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.

Prior Authorization and Notification Resources

Current Policies and Clinical Guidelines

Provider Administrative Manual and Guides

Overview

The University of Washington’s Collaborative Care Model is an integrated, evidence-based approach that aims to bring together primary care providers and behavioral health care providers to deliver care to eligible members. The Collaborative Care Model gives the PCP access to additional care management support and regular psychiatric consultation for members receiving behavioral health treatment. The Washington State Health Care Authority and UnitedHealthcare Community Plan are encouraging care providers to learn more about how they may integrate this model into their practice.

Interested? The first step is to submit an attestation – Washington State Health Care Authority form 13- 0017 – to become an approved collaborative care provider for UnitedHealthcare Community Plan members. Email the form to us at WAcollaborativecare@uhc.com. After that, one of our Transformation Advocates will contact you.

Helpful Resources 

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

UnitedHealthcare is here to help your practice successfully transition to the integrated managed care (IMC) clinical care model.

If you have any questions, please contact the clinical practice performance consultants at WACollaborativeCare@uhc.com.

For more training and educational resources, please click here.

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

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.

Visit UHCCommunityPlan.com/WA 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 of Washington - Apple Health

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

The Partnership Access Line (PAL) is a mental health consultation resource available to all primary care providers to help practices deliver more effective mental health care for any child they see, regardless of insurance. PAL also includes PAL for Moms, which is focused on support for postpartum depression.   Learn more about PAL and upcoming care provider training on the Seattle Children’s website, seattlechildrens.org/PAL.

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.  

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.

Current News, Bulletins and Alerts

Medical Policy Documentation Requirement Updates Frequently Asked Questions - UnitedHealthcare Community Plans

Last Modified | 10.20.2020

We’ve refined medical policy documentation requirements and enhanced clinical coverage criteria for various procedures. This document contains information on effective dates by state and frequently asked questions.

Learn More
Pediatric Private Duty Nursing Hours Scoring Tool - UnitedHealthcare Community Plan of Washington

Last Modified | 10.12.2020

Calculate the number of eligible Private Duty Nursing hours. The scoring tool uses a point system for each required technology and skilled nursing need.

Learn More
Applied Behavior Analysis (ABA) Care Provider Quick Reference Guide

Last Modified | 08.11.2020

Check patient eligibility and benefits using the online tools at UHCprovider.com/link or by calling the Behavioral Health number on the member’s ID card.

Learn More
Update to Procedure to Modifier Policy for “Always Therapy” Codes – Effective July 1, 2019 for UnitedHealthcare Community Plan of CA, HI, FL, LA, MD, MA, MI, MS, NE, NJ, NY, OH, PA, RI, WA, WI, VA

Last Modified | 05.14.2020

UnitedHealthcare Community Plan is updating its Procedure to Modifier Policy for claims for dates of service on or after July 1, 2019. Physical therapy (GP), occupational therapy (GO) or speech-language pathology (GN) modifiers will be required on “Always Therapy” codes to align with the Centers for Medicare & Medicaid Services (CMS).

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DUR Educational Newsletter: Safety in Respiratory Therapy - UnitedHealthcare Community Plan

Last Modified | 04.24.2020

The National Asthma Education and Prevention Program (NAEPP) published guidelines for the treatment of asthma in2007.¹ The guidelines outline goals of therapy that include the prevention of recurrent exacerbation and need for emergency department or hospital care, the prevention of reduced lung growth in children or loss of lung function in adults, and the optimization of pharmacotherapy with minimal or no adverse effects.

Learn More
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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.