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For UnitedHealthcare Community Plan of Wisconsin

Welcome

For UnitedHealthcare Community Plan of Wisconsin

UnitedHealthcare Community Plan of Wisconsin 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

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

Provider Call Center                   

877-651-6677
24/7 Customer Service
8 a.m. - 5 p.m. for Member Advocates

Postal Mailing Address               

UnitedHealthcare Community Plan
10701 W. Research Drive
Wauwatosa, WI 53226

Claims Mailing Address

UnitedHealthcare Community Plan
PO Box 5280
Kingston, NY 12402-5280

Utilization Management Appeals Address

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

Claims Appeals Mailing Address

Part C Appeals or Grievances:
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

Additional Information

UnitedHealthcare Behavioral Health
PO Box 30757
Salt Lake City, Utah 84130-0757

 

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/WI 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 Wisconsin

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

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
Inappropriate Primary Diagnosis Policy, Facility - Effective November 1, 2020 - UnitedHealthcare Community Plan of AZ, FL, MD, MI, MS, OH, PA, TN, VA, and WI

Last Modified | 09.29.2020

UnitedHealthcare Community Plan is implementing a new Inappropriate Primary Diagnosis Policy, Facility, for facility claims with dates of services on or after November 1, 2020.

Learn More
Electronic Visit Verification for Personal Care Services - UnitedHealthcare Community Plan of Wisconsin

Last Modified | 09.18.2020

On Nov. 2, 2020, the Wisconsin Department of Health Services (DHS) will begin implementing electronic visit verification (EVV) for personal care and supportive home care services that include personal care.

Learn More
Emergency Room Copay Waived for BadgerCare Plus Members

Last Modified | 07.14.2020

Due to the changes the Wisconsin Department of Health Services has made to the Medicaid program, some members may have to pay an $8 copay if they choose to get medical care in the emergency room when it’s not an emergency.

Learn More
UnitedHealthcare Community Plan Wisconsin Now Available Statewide: Expanded Coverage in Buffalo, Dunn, Iowa, Iron, Pepin and Rusk Counties

Last Modified | 03.06.2020

Effective March 1, 2020, UnitedHealthcare Community Plan now provides health insurance coverageto Medicaid recipients in all 72 Wisconsin counties.

Learn More
View More News

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.