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.
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Contact Us
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Provider Call Center
(800) 600-9007
Monday-Friday, 8 a.m. – 5 p.m.
Postal Mailing Address
UnitedHealthcare Community Plan
9200 Worthington Road, 3rd Floor
Westerville, OH 43082
Claims Mailing Address
UnitedHealthcare Community Plan
P.O. Box 8207
Kingston, NY 12402
Utilization Management Appeals Address
UnitedHealthcare Community Plan
Attn: Complaint and Appeals Department
P.O. Box 31364
Salt Lake City, UT 84131
Fax: (801) 994-1082
Claims Appeals Mailing Address
UnitedHealthcare Community Plan
Attn: Complaint and Appeals Department
P.O. Box 31364
Salt Lake City, UT 84131
Fax: (801) 994-1082
UHC Connected™ For MyCare Ohio 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
Fax: (801) 994-1082
Medicare Part D Grievances:
UnitedHealthcare Community Plan
Attn: Complaint and Appeals Department
P.O. Box 31364
Salt Lake City, UT 84131
Fax: (801) 994-1082
Medicare Part D Appeals:
UnitedHealthcare Community Plan
Attn: Part D Standard Appeals
P.O. Box 6103
Cypress, CA 90630-9998
Fax: (877) 960-8235
Credentialing and Attestation
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For Credentialing and Attestation updates, visit the Ohio Department of Medicaid website.
Need to make a change to your provider or facility directory information?
Visit the Demographics and Profiles Section
External Medical Review (EMR)
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External medical review (EMR) is a review process conducted by an independent, external medical review entity. It is initiated by a provider who disagrees with the decision of a managed care organization (MCO) and/or the OhioRISE (Resilience through Integrated Systems and Excellence) plan to deny, limit, reduce, suspend or terminate a covered service for lack of medical necessity.
If you would like more information on EMRs, the Ohio Department of Medicaid (ODM) provides some helpful provider resources, including Frequently Asked Questions (FAQs), a Prior Authorization Denial Grid and the EMR process flow. All can be found on the ODM website.
Join Our Network
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Behavioral Health Providers
Learn how to join the Behavioral Health Network, review Community Plan Behavioral Health information, or submit demographic changes atCommunity 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 networkis found in the UnitedHealthcare Community Plan Care Provider Manuals.
Learn about requirements forjoining our network.
Medicaid Managed Care Rule
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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.
Member Information: Current Medical Plans, ID Cards, Provider Directories, Dental & Vision Plans
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Visit UHCCommunityPlan.com/OHfor 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 Ohio
- UnitedHealthcare Connected® for MyCare Ohio
- UnitedHealthcare Dual Complete (HMO SNP)
- UnitedHealthcare Dual Complete (HMO-POS SNP)
Member plan and benefit information can also be found atUHCCommunityPlan.com/OHandmyuhc.com/communityplan.
Search for a Care Provider
- UnitedHealthcare Community Plan of Ohio
- UnitedHealthcare Connected® for MyCare Ohio
- UnitedHealthcare Dual Complete® (HMO SNP)
- UnitedHealthcare Dual Complete® (HMO-POS SNP)
Search for a Dentist
Need to make a change to your provider or facility directory information?
Visit the Demographics and Profiles Section
PCP Membership Reports
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CommunityCare
The best way for primary care providers (PCPs) to view and export thefull 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 MedicareSpecial 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 ourQuick Reference Guide.If you’re not familiar with UnitedHealthcare Provider Portal, go toUHCprovider.com/portal.
CommunityCare Overview
Provider Contracts
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The Ohio provider contract with United HealthCare Community Plan is listed below.
Reporting Health Care Fraud, Waste and Abuse
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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.Ifyou 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 at1-844-359-7736or visituhc.com/fraud to report any issues or concerns.
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.
