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UnitedHealthcare Community Plan of Pennsylvania Homepage

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 Community Plan offers a Special Needs Unit (SNU) to help members who have special needs because of on-going physical, developmental, emotional or behavioral conditions.

If you have a UnitedHealthcare Community Plan patient who has a special need, please consider calling or having your patient call the Special Needs Unit at 877-844-8844 or Member Services at 800-414-9025. 

Provider Call Center

800-600-9007, Monday-Friday, 8 a.m. – 5 p.m.

Postal Mailing Address

UnitedHealthcare Community Plan
680 Blair Mill Road
Horsham, PA 19044

Claims Mailing Address

UnitedHealthcare Community Plan
PO Box 8207
Kingston, NY 12402-8207

Utilization Management Appeals Address 

UnitedHealthcare Community Plan
Attn: Grievances and Appeals
PO Box 31364
Salt Lake City, UT 84131-0364

Claims Appeals Mailing 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

For questions about Credentialing and Attestation updates, connect with us through chat 24/7 in the UnitedHealthcare Provider Portal.

Connect with us through chat 24/7 in the UnitedHealthcare Provider Portal. For additional contact information, visit our Contact us page.

Need to make a change to your provider or facility directory information? 

Visit the Demographics and Profiles Section

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. 

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/PA for current member plan information including sample member ID cards, provider directories, dental plans, vision plans and more.

Plan information is available for:

  • Pennsylvania UnitedHealthcare Community Plan for Families
  • Pennsylvania UnitedHealthcare Community Plan for Kids

Member plan and benefit information can also be found at UHCCommunityPlan.com/PA and myuhc.com/communityplan.

Search for a Care Provider 

Search for a Dentist

Need to make a change to your provider or facility directory information? 

Visit the Demographics and Profiles Section

Forms for Medical Assistance members are available from the Pennsylvania Department of Human Services website. Most forms are available in both English and Spanish. Available forms include:

  • Abortion Consent Form
  • Eligibility Determination Form
  • Hysterectomy Consent Form
  • Medical Assistance Provider Order Form
  • Medical Evaluation Plan of Care Form
  • Newborn Eligibility Form
  • Obstetrical Needs Assessment Form
  • Outpatient Services Authorization Request Form
  • Recipient Statement Forms
  • Service Coordination Plan
  • Sterilization Consent Form

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.  

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.