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UnitedHealthcare Community Plan of Pennsylvania

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.

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Resources

Prior authorization and notification

Access prior authorization and notification information.

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Current policies and clinical guidelines

Guidelines for our quality and health management programs. 

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Provider Administrative Manuals and Guides

Helpful information on topics such as prior authorization, processing claims and protocols.

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Claims and payments

Online tools and resources to help you manage your practice’s claim submission and payments.

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Training and education

A list of our current training materials for care providers.

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Pharmacy resources and physician-administered drugs

Find pharmacy information related to prescription drugs.

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UnitedHealthcare Community Plan offers the Enhanced Member Support Unit (EMSU) formerly known as the Special Needs Unit (SNU). The primary purpose of the EMSU is to ensure that each member with special health care needs and/or health-related social needs receives access to appropriate primary care, specialist and supportive service providers trained and skilled in the needs of the member. 


If you have a UnitedHealthcare Community Plan patient with a special health care need, please consider calling or having your patient call the EMSU 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 Rd.
Horsham, PA 19044


Claims mailing address

UnitedHealthcare Community Plan
P.O. Box 8207
Kingston, NY 12402-8207


Utilization management appeals address

UnitedHealthcare Community Plan
Attn: Grievances and Appeals
P.O. 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. For additional contact information, visit our Contact us page.


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

Visit the provider data updates and attestation

Behavioral health providers

Learn how to join the behavioral health network, review behavioral health information or submit demographic changes at Community Plan Behavioral Health.


Facility/hospital-based, group/practice and individually contracted clinicians

The state-specific requirements and process on how to join the UnitedHealthcare Community Plan network are 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 provider data updates and attestation


Language services

Contacts for deaf, hard of hearing and language barriers


Information to help your patients who are our members access help in-person or by phone.

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 to Microsoft Excel
  • 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 in the UnitedHealthcare Provider Portal, please see our user guide. If you’re not familiar with UnitedHealthcare Provider Portal, visit our portal resources page.

Visit CommunityCare
CommunityCare Overview

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 844-359-7736 or visit uhc.com/fraud to report any issues or concerns.  

Program Overview

The Early Periodic Screening, Diagnosis and Treatment (EPSDT)/Bright Futures program combines screening, diagnostic and treatment services to Medicaid and CHIP-eligible individuals from birth to age 21. These services give children early access to preventive and comprehensive health care to help prevent disease and/or detect disabilities in their early stages, when they are more effectively treated.

 

References:

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 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 UnitedHealth Group 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 Policies and Clinical Guidelines section at left.

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).


CPT® is a registered trademark of the American Medical Association.