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
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Current Policies and Clinical Guidelines
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Provider Administrative Manual and Guides
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Contact Us
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Provider Call Center
866-815-5334available from8 a.m. – 5 p.m. CST (except State designated holidays)
Provider Relations Team
Email:Missouri_PR_Team@uhc.com
Network Management Team
Phone:866-574-6088
Email:mo_network_mgmt@uhc.com
Mailing Address
UnitedHealthcare Community Plan of Missouri
13655 Riverport Drive
Maryland Heights, MO 63043
Claims & Appeals Information
Claims Mailing Address
UnitedHealthcare Community Plan
PO Box 5240
Kingston, NY 12402-5240
Appeals Mailing Address
UnitedHealthcare Community Plan of Missouri
Attention: Provider Dispute
P.O. Box 31364
Salt Lake City, Utah 84131-0364
Behavioral Health Contact Information
Optum Behavioral Health
Phone:866-815-5334
Online:https://www.providerexpress.com/content/ope-provexpr/us/en.html
Other Services
Dental Care Contact Information
UnitedHealthcare Dental
Phone:855-934-9818
Online:https://uhcpwp.sciondental.com/PWP/Landing
Member Transportation Information
Medical Transportation Management
Phone:866-292-0359
Online:https://www.mtm-inc.net/
Vision Care Contact Information
March Vision Care
Phone:844-616-2724
Online:https://marchvisioncare.com/
Credentialing and Attestation
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For Credentialing and Attestation updates, contact the National Credentialing Center at 1-877-842-3210.
Integrated Care
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UnitedHealthcare is here to help your practice successfully transition to the integrated care clinical model.
If you have any questions, please contact thecommunity integration team atmocollaborativecare@uhc.com.
For more training and educational resources, please clickhere.
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.
Pediatric Care Network (PCN)
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Pediatric Care Network will provide delegated medical management services for UHC Community Plan Pediatric Care Network members including case management, utilization management and disease management. Resources are available for providers including reference guides, office forms, frequently asked questionsand more.
Member Information: Current Medical Plans, ID Cards, Provider Directories, Dental & Vision Plans
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Visit UHCCommunityPlan.com/MOfor current member plan information including sample member ID cards, provider directories, dental plans, vision plans and more.
Plan information is available for:
- Care Improvement Plus Dual Advantage
- Missouri HealthNet Managed Care
- UnitedHealthcare Dual Complete
Member plan and benefit information can also be found atUHCCommunityPlan.com/MOandmyuhc.com/communityplan.
Additional health benefits and benefits updates can be found athttps://www.uhccommunityplan.com/mo/medicaid/mo-health-net.
Provider Directories
- Eastern Region
- Central Region
- Western Region
- Southwest Region
Member Handbooks
- Missouri HealthNet Member Handbook - English and Spanish Available
- Missouri HealthNet Member Benefits Grid
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 Medicaid Enrollment
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Effective January 1, 2018, all providers servicing Missouri Medicaid members must be enrolled with Missouri HealthNet.Use the application form below that best applies to your situation.
Individual Provider Enrollment
Missouri HealthNet Individual Providers Application
Organizational Provider Enrollment
Missouri HealthNet Large Provider Organization Application
Provider Search, Referral Listings and Home and Community Based Services Providers
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Search for a care provider by plan name:
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.
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.
Learn more about the Dual Special Needs Program
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.
