Is unitedhealthcare community plan medicaid or medicare

The UnitedHealthcare Community Plan is managed by UnitedHealthcare Insurance Company, which has a membership of 40 million people. The plan provides low-cost medical coverage to Medicaid and Medicare Advantage recipients and is one of the largest providers of Medicaid coverage to states in the U.S.  The Medicare Advantage plans combine the benefits of Original Medicare with additional features while allowing recipients to use their Medicaid benefits.

UnitedHealthcare Community Plan options are available in Arizona, Delaware, Florida, Hawaii, Iowa, Kansas, Louisiana, Maryland, Massachusetts, Michigan, Mississippi, Nebraska, Nevada, New Jersey, New Mexico, New York, Ohio, Pennsylvania, Rhode Island, Tennessee, Texas, Washington, and Wisconsin. Network size differs from state to state. For example, in New York the plan serves 43 counties through 235 hospitals and over 65,000 doctors.

UnitedHealthcare Community Plan partners with local communities to improve health awareness for women and children. The company helps educate the elderly on health programs they can access and participates in the Farm to Fork Program in Mississippi to help encourage healthy eating habits. UnitedHealthcare Community Plan also helps local communities obtain grants.

Like many insurance companies, UnitedHealthcare Community Plan’s product offerings include HMO plans.

Our role in America’s health

At UnitedHealthcare Community & State, we serve millions of Americans, many of whom contend with complex medical conditions on top of a daily challenge to make ends meet. That is why we are united behind our mission: to help people live healthier lives and make the health system work better for everyone.

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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

COVID-19 Resources for Providers

• In most areas, prior authorization requirements, concurrent utilization reviews for inpatient admissions and prior authorization required for placement in post-acute care settings resumed on May 26, 2020. This is consistent with the Governor of New Jersey’s Executive Order No. 145 permitting the resumption of elective and other surgical procedures. 
• NJ Dept. of Human Services: Community provider requests for the state’s Coronavirus Relief Fund (CRF) reimbursement program due by Nov. 13, 2020

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Provider Service Center

888-362-3368, available Monday – Friday from 6:00 a.m. – 6:00 p.m.

Claims Address

Medicaid and NJ Familycare

UnitedHealthcare Community Plan
P.O. Box 5250
Kingston, NY 12402-5250
Payer ID: 86047 

UnitedHealthcare Dual Complete ONE

UnitedHealthcare Dual Complete® ONE
P.O. Box 5250
Kingston, NY 12402-5250
Payer ID: 86047

Claims Appeal Address

Part C Appeals and Grievance Department
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

UM Appeals

Medicaid and NJ Familycare

UnitedHealthcare Community Plan
Attn: UM Appeals Coordinator
P.O. Box 31364
Salt Lake City, UT 84131

UnitedHealthcare Dual Special Needs (HMO SNP)

UnitedHealthcare Dual Complete One
Attn: UM Appeals Coordinator
P.O. Box 31364
Salt Lake City, UT 84131

All Providers

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

Credentialing and Recredentialing for Managed Long-Term Care Services and Supports (MLTSS) Providers

All documentation, inquires, and communication related to MLTSS credentialing and recredentialing information can be emailed to us at .

• If you are a participating MLTSS provider, you need to send us your recredentialing documents each year to ensure we have your most current complete required documentation.
• All forms and documents can be emailed to . Include the name of the facility and the words “Recredentialing Application” in the subject line.
• Documents can also be mailed to:
  • UnitedHealthcare Community Plan
    Attn: MLTSS Credentialing
    283-289 Market Street 12th Floor, Suite 1202
    Newark, NJ 07102

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. 

Managed Long-Term Care Services and Supports (MLTSS) Providers

If you are interested in becoming a participating MLTSS provider, please email  for more information or to request a credentialing application. Include the name of the facility and the words “Credentialing Application” in the subject line.

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.

The best way for primary care providers (PCPs) to view and export the full member roster is using the CommunityCare tool, which allows you to:  

• Identify Medicaid recipients who need to have their Medicaid recertification completed and approved by the State Agency 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 Excel
• View most Medicaid and Medicare 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, please see our Quick Reference Guide. If you’re not familiar with our portal, go to UHCprovider.com/portal.

Check out Care Conductor in the UnitedHealthcare Provider Portal under Clinical & Pharmacy.

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.  

If any provider or person discovers fraud and/or abuse occurring in any State or federally-funded health benefit program, they should report it to the Office of State Comptroller, New Jersey Medicaid Fraud Division hotline at 1-888-937-2835 or website at http://nj.gov/comptroller/divisions/medicaid.

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

Last Modified | 10.28.2022

Effective Jan. 1, 2023, UnitedHealthcare will manage the Medicare component of some HIDE or FIDE-AIP plans.

Learn More

Last Modified | 10.13.2022

Effective for dates of service starting Dec. 1, 2021, UnitedHealthcare Community Plan of New Jersey is enforcing the taxonomy code requirement for all Medicaid claims submissions.

Learn More

Last Modified | 09.29.2022

As of Nov. 1, 2022, we’re expanding prior authorization and site of service for Community Plan of New Jersey.

Learn More

Last Modified | 07.06.2022

Effective with dates of service on or after Aug. 1, 2022, United HealthCare Community Plan of New Jersey will no longer reimburse CPT Code 98943.

Learn More

Last Modified | 06.30.2022

Effective July 1, 2022, in-home health care professionals will be required to demonstrate progress towards using an electric visit verification (EVV) system.

Learn More

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Deficit Reduction Act / False Claims – NJ Specific Policy

This Policy requires Employees (and Employees of applicable contractors and agents of the Company) to comply with the federal False Claims Act, state false claims acts, and similar state and local laws and applicable agency policy. View our policy.

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. 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.

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