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 forupdates.
Are you a member looking for health plan or provider information?
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Prior Authorization and Notification Resources
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Current Policies and Clinical Guidelines
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Provider Administrative Manual and Guides
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Find Local COVID-19 Diagnostic Testing Locations
Use these online tools to help find your patients find a COVID-19 diagnostic testing location:
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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.
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, Health Waivers and More
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Visit UHCCommunityPlan.com/FL for current plan names, overview of eligibility information, doctor look up and more.
Member Health Waivers
If you are a provider of a member whose health was previously cared for under one of the following waivers, please contact Provider Services for extra help understanding your full benefit program:
- Project Aids Care (PAC) Waiver
- Traumatic Brain Injury (TBI) or Spinal Cord Injury (SCI) Waiver
- Adult Cystic Fibrosis (ACF) Waiver
You can reach our Provider Services team by calling the number on the back of your members ID card, or by referencing the contact numbers below:
- Managed Medical Assistance (MMA): Connect with us through chat 24/7 in theUnitedHealthcare Provider Portal.
- Long Term Care (LTC): 800-791-9233
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, visit our Portal Resources page.
CommunityCare Overview
Provider Directories
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Search for a Care Provider
- UnitedHealthcare Community Plan M*Plus (MMA)
- UnitedHealthcare Community Plan (Medicaid)
- UnitedHealthcare Dual Complete® LP Plan 1 (HMO SNP)
- UnitedHealthcare Dual Complete® RP - FL
- UnitedHealthcare Dual Complete®RP ONE (Regional PPO SNP)
- UnitedHealthcare Health & Home Connection
Search for a Dentist
Need to make a change to your provider or facility directory information?
Visit the Demographics and Profiles Section
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/fraudto report any issues or concerns.
Resources:
- SMMC Resource Guide - This reference guide provides a list of the departments at UnitedHealthcare that may be helpful in assisting with coordination and authorization of services that a member may need
- Continuity of Care - UnitedHealthcare Community Plan members transitioning to a new plan or provider can still see their current provider for up to 60 days. This ensures a smooth transition and uninterrupted medical treatment.
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.
