Patient and Member Support

Last Update:  January 18, 2022, 3:00 p.m. CT

Information contained in the topics below provides information, resources, and links to help practitioners support our Community and State members and our Quality programs.

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As a reminder, UnitedHealthcare Community Plan has appointment availability requirements for PCPs and specialists. The requirements apply to routine, urgent and after-hours care. For specific information, please refer to your provider administrative manual, which can be found at UHCprovider.com/en/admin-guides/cp-admin-manuals.html

The UnitedHealthcare Community Plan Case Management program is a holistic approach to care for members with complex needs, especially for those with chronic conditions. The goal is to keep our members in the community with the resources necessary to maintain the highest functional status possible.

What can the UnitedHealthcare Community Plan case manager provide for your patients?

  • Telephonic contact with members and facilitation of home visits
  • Health education and educational materials
  • A health assessment with stratification of diagnosis and severity of condition and
    psychosocial needs
  • Referral to community resources as needed
  • Assistance with medical transportation
  • Arrangements for durable medical equipment (DME) and ancillary services as needed or ordered by the physician
  • Outreach to members to promote assistance with keeping doctor's appointments
  • Work with members to identify and address barriers to seeking health care and following their medical treatment plan of care

How to refer
For more information or to make a referral, call our referral line at 877-542-9235.

UnitedHealthcare Community Plan has identified evidence-based clinical practice guidelines that are available as resources. The guidelines cover a variety of conditions, such as diabetes, asthma, depression, as well as preventive care. They can be found at UHCprovider.com/cpg or you may call 877-542-9235 for a copy.

UnitedHealthcare wants to underscore the importance of ongoing communication between primary care providers (PCP) and specialists. PCPs and specialists share responsibility for communicating essential patient information regarding consultations, treatment plans and referrals. Relevant information from the PCP should include the patient's history, diagnostic tests and results and the reason for the consultation. The specialist is responsible for timely communication of the results of the consultation and ongoing recommendations and treatment plans.

The information exchange between practitioners should be timely, relevant and accurate to facilitate ongoing patient management. The partnership between the PCP and specialist is based on the consistent exchange of clinical information and is a critical factor in providing quality patient care.
The provider administrative guide addresses coordination of care and expectations of our providers. For more information, please refer to the provider administrative guide for the applicable state at UHCprovider.com/en/admin-guides/cp-admin-manuals.html.

UnitedHealthcare serves a diverse group of individuals. Information about our membership is collected and analyzed in order to provide our members with health care services that meet their individual cultural and language needs.  Each UnitedHealthcare Community Plan has unique membership with its own cultural and language needs. An example of some of our diverse memberships by state can be found in the table below:

State

2nd language

3rd language

4th language

5th language

6th language

7th language

Arizona

Spanish

Vietnamese

Arabic

Chinese

-

-

California

Spanish

Mandarin

-

-

-

-

Florida

Spanish

Creole

-

-

-

-

Hawaii

Chinese

Filipino

Korean

Vietnamese

Tagalog

-

Indiana

-

-

-

-

-

-

Kansas

Spanish

Vietnamese

-

-

-

-

Kentucky

Spanish

-

-

-

-

-

Louisiana

Spanish

Vietnamese

Arabic

-

-

-

Maryland

Spanish

Vietnamese

-

-

-

-

Michigan

Arabic

Spanish

Bengali

-

-

-

Mississippi

Spanish

-

-

-

-

 

Missouri

Spanish

-

-

-

-

-

Nebraska

Spanish

Arabic

Vietnamese

-

-

-

New Jersey

Spanish

Korean

Arabic

Chinese

Persian

-

New York

Spanish

Chinese

Mandarin

Russian

Korean

Arabic

Ohio

Spanish

Nepali

Arabic

Somali

Swahili

Burmese

Pennsylvania

Spanish

Nepali

Arabic

Vietnamese

Cambodian

-

Rhode Island

Spanish

Portuguese

-

-

-

-

Tennessee

Spanish

-

-

-

-

 

Texas

Spanish

Vietnamese

-

-

-

-

Virginia

Spanish

Arabic

Vietnamese

-

-

-

Washington

Spanish

Vietnamese

Russian

Chinese

Korean

Arabic

Wisconsin

Spanish

Hmong

Arabic

Burmese

Somali

Laotian

UnitedHealthcare members have the right to receive care that is culturally appropriate and respects their cultural and ethnic background and origins. Upon enrollment, information regarding a member’s primary language is obtained and members may receive assistance in choosing a PCP who will meet their needs. We continue to work to identify gaps in care related to member language and cultural needs. We have tools to help reduce these gaps, promote cultural awareness, improve culturally competent care, and assist practitioners in recognizing and treating health disparities.  Cultural training and associated tools are located at UHCprovider.com/en/resource-library/patient-health-safety/cultural-competency.html. The website includes training on cultural competency, continuing education, and includes resources such as those listed below:

  • Quick reference guide – Understanding Cultural Competency and the Americans with Disabilities Act
  • The Cross-Cultural Health Care program
  • Cultural Orientation Resource Center

Additionally, there are health equity courses provided by OptumHealth Education On-Demand. CMEs are available when taking the courses, such as “Advancing Health Equity Education Series,” “Social Inequities and Health and How to Effectively Address Them” and “Caring for the LGBTQ+ Community: An Introduction.” These courses can be found on Health Equity | OptumHealth Education.

Language assistance is available to help providers communicate with non-English speaking members. Services include a telephone language line, in-person interpreters, and video services. If you need assistance in communicating with one of our members you may call customer service for assistance at 877-542-9235.

Just a reminder, the UnitedHealthcare Community Plan member rights and responsibilities can be found in the care provider manual. Member rights and responsibilities are distributed to new members upon enrollment. On an annual basis, members are referred to their handbook to review their member rights and responsibilities.

UnitedHealthcare Community Plan pharmacy updates are available at UHCprovider.com > Menu >  Health Plans by State > select state > Medicaid (Community Plan) > Pharmacy Resources and Physician-Administered Drugs.

You can find this information online:

  • A list of covered pharmaceuticals, including restrictions and preferences
  • Pharmaceutical management procedures
  • Explanations on limits or quotas
  • How to submit and support special requests
  • Generic substitution, therapeutic interchange and step-therapy protocols

Call the pharmacy hotline at 800-922-1557.

UnitedHealthcare Community Plan staff performs concurrent reviews on inpatient stays in acute, rehabilitation and skilled nursing facilities, as well as prior authorization reviews of selected services. The Prior Authorization and Notification tool provides a listing of services that require prior authorization. You can learn more about the tool at UHCprovider.com/paan. Training is available in the Videos and Training section of the website. A physician reviews all cases in which the care does not appear to meet guidelines. Decisions regarding coverage are based on the appropriateness of care and service and existence of coverage. We do not provide financial or other rewards to our physicians for issuing denials of coverage or for underutilizing services.

If you have questions or would like specific utilization management criteria, you can talk to our staff. Call toll-free at 877-542-9235. Staff is available 8 hours per day from 9 a.m.–5 p.m. ET.