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UnitedHealthcare Community Plan of Hawaii Homepage

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Provider manual
09.23.2024 - An updated Hawaii Care Provider Manual is now available.

Hawaii: Registration requirement for Medicaid providers
The Hawaii Department of Human Services (DHS)/Med-QUEST Division (MQD) requires all care providers who serve QUEST members to register with the new MQD provider enrollment system, HOKU, by December 31, 2023.  Learn more. 

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.

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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UnitedHealthcare QUEST Integration Program

Hours of Operation

Monday - Friday, from 7:45 a.m. - 4:30 p.m. Hawaiian Standard Time (HST) 

Health Plan Administrative Office

1132 Bishop Street., Suite 400
Honolulu, HI 96813
Phone: 1-808-535-1000 

Provider / Member Services Information

Call Center

  • 1-888-980-8728
  • Medicare Advantage-Dual Special Needs Program (MA-DSNP): 1-866-622-8054
  • TTY: 711 (Hearing Impaired)

Prior Authorization

  • 1-888-980-8728
  • TTY: 711 (Hearing Impaired)
  • Fax: 1-800-267-8328

Claims Mailing Address

UnitedHealthcare Community Plan QUEST Integration
P.O. Box 31365
Salt Lake City, UT 84131-0365
Payer ID#: 87726 (EDI Claims Submission)

For ERA, use Payer ID# 04567 

Behavioral Health Services Information

Call Center

  • 1-888-980-8728
  • Medicare Advantage-Dual Special Needs Program (MA-DSNP): 1-866-622-8054
  • TTY: 711 (Hearing Impaired)

Prior Authorization

Fax: 1-877-840-5581
Website: www.providerexpress.com 

Claims Mailing Address

Optum
P.O. Box 30757
Salt Lake City, UT 84130-0757
Payer ID#: 87726 (EDI Claims Submission)

For ERA, use Payer ID# 04567 

Pharmacy Contact Information

  • 1-888-980-8728
  • TTY: 711 (Hearing Impaired)

Prior Authorization Phone: 1-800-310-6826
Prior Authorization Fax: 1-866-940-7328
Help Desk Phone: 1-800-797-9791
Bioscrip-Specialty Drug Phone: 1-800-584-0265
Formulary Information:  uhccommunityplan.com/hi.html 

Transportation Services Contact Information

Reservations: 1-866-475-5744
Ride Assistance: 1-866-475-5745
TTY (Heaing Impaired): 1-866-288-3133

UnitedHealthcare is her to help your practice successfully transition to the integrated care clinical model.

If you have any questions, please contact the community integration team at hicollaborativecare@uhc.com.

For more training and educational resources, please click here. 

Thank you for your interest in becoming a network care provider with UnitedHealthcare Community Plan of Hawaii. In joining our network, you’ll become part of a group of physicians, health care professionals and facilities who share our commitment to helping people live healthier lives and making the health care system better for everyone.

To join our network:

1. Submit your credentialing application

Credentialing is required for all licensed independent practitioners and facilities to participate in the UnitedHealthcare network. We partner with MDX and Optum to help manage the credentialing process. Please follow these steps to submit your credentialing application based on your practicing specialty. These are also the resources to call if you have a question or want to check the status of your application.

  • General Care Providers (excluding specialties listed below): Most care providers will work with MDX Hawaii, Inc. to begin the application process. You can reach MDX at 808-532-6989, option 2 from 8 a.m. to 5 p.m. Hawaii Time, Monday through Friday.
  • Mental Health or Substance Abuse Practitioners: If you work in this specialty area, you’ll contact Optum Behavioral Health Solutions, which handles credentialing and contracting on behalf of UnitedHealthcare. To get started, go to providerexpress.com (look under “Our Network” for specific instructions) or call 800-817-4705.
    If you also provide medical services in addition to mental health and substance abuse services, you’ll work with MDX for credentialing. Please follow the instructions noted above.
  • Home and Community-Based Services: Please email UnitedHealthcare Community Plan hcbsprovidernetwork@uhc.com or call 888-980-8728. 
  • Dental: If you work in this specialty, you’ll contact Dental Benefit Partners to begin the credentialing process. To get started, visit https://www.uhcdental.com/ (look under “Join Our Network”) or call 800-822-5353.

2. Complete your participation agreement

After credentialing is complete, UnitedHealthcare Community Plan will send you a Participation Agreement (contract) through a secure application called DocuSign. (If we don’t have a valid email address for you, we’ll mail you the Participation Agreement.) Once contracting is completed, you’ll receive the countersigned agreement with your effective date.

  • If you’re joining a medical group that already has a participation agreement, you’ll be added to the group agreement once credentialing has been approved. A new contract will not be issued.

3. Get connected with us electronically

Once you are credentialed and have received your countersigned agreement, your next step is to know how to get connected with us electronically so you can take advantage of our online tools, paperless options, electronic payments and more. Review our Quick Start Guide for the most recent checklist. 

We’re here to help! If you have questions, please call us at 888-980-8728 from 7:45 a.m. to 4:30 p.m. Hawaii Time, Monday through Friday.

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.

Visit UHCCommunityPlan.com/HI for current member plan information including sample member ID cards, provider directories, member handbooks, dental plans, vision plans and more.

Plan information is available for:

  • Hawaii UnitedHealthcare Community Plan QUEST Integration Program

Member plan and benefit information can also be found at UHCCommunityPlan.com/HI and myuhc.com/CommunityPlan.

Guides:

CommunityCare

The best way for primary care providers (PCPs) to view and export the full 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
  • View most Medicaid and Medicare Special 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 our Quick Reference Guide. If you’re not familiar with UnitedHealthcare Provider Portal, visit our Portal Resources page.

Go to CommunityCare Now
CommunityCare Overview

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.  

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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.