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For UnitedHealthcare Community Plan of New York

Welcome

For UnitedHealthcare Community Plan of New York

UnitedHealthcare Community Plan of New York 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.

Prior Authorization and Notification Resources

Current Policies and Clinical Guidelines

Provider Administrative Manual and Guides

Provider Call Center

866-362-3368

Mailing Address

UnitedHealthcare Community Plan
77 Water Street, 14th Floor
New York, NY 10005

Claims Mailing Address

UnitedHealthcare Community Plan
PO Box 5240
Kingston, NY 12402-5240

Utilization Management Appeals Address

UnitedHealthcare Community Plan
PO Box 31364
Salt Lake City, UT 84131-0364
Fax: (801) 994-1082

Claims Appeals Mailing Address

Part C Appeals or Grievances

UnitedHealthcare Community Plan
Attn: Complaint and Appeals Department
P.O. Box 31364
Salt Lake City, UT 84131-0364
Fax: (801) 994-1082

Medicare Part D Appeals

UnitedHealthcare Community Plan
Attn: Part D Standard Appeals
P.O. Box 6103
Cypress, CA 90630-9998
Fax: (877) 960-8235

Medicare Part D Grievances

UnitedHealthcare Community Plan
Attn: Complaint and Appeals Department
P.O. Box 31364
Salt Lake City, UT 84131
Fax: (801) 994-1082

For Credentialing and Attestation updates, contact the National Credentialing Center at 1-877-842-3210.

Facility/Hospital-Based Providers, Group/Practice Providers and Individually-Contracted Clinicians

Learn about requirements for joining our network.

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.

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

Plan information is available for:

  • New York Child Health Plus
  • New York Community Plan MLTSS
  • New York Essential Plan
  • New York UnitedHealthcare Community Plan
  • New York UnitedHealthcare Wellness4Me

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

The best way for primary care providers (PCPs) to view and export the full member roster is using the CommunityCare tool on Link, which allows you to:  

  • See a complete list of all members, or just members added in the last 30 days
  • Export the roster to Excel
  • View most Medicaid and Medicare 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, please see our Quick Reference Guide. If you’re not familiar with Link, go to UHCprovider.com/link.

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, UnitedHealthcare works to detect, correct and prevent fraud , waste  and abuse  in the health care system.

Call us at 1-844-359-7736 or at uhc.com/fraud to report any issues or concerns. 

Current News, Bulletins and Alerts

Inappropriate Primary Diagnosis Policy, Facility - Effective January 1, 2021 - UnitedHealthcare Community Plan of NJ and TX

Last Modified | 09.29.2020

UnitedHealthcare Community Plan is implementing a new Inappropriate Primary Diagnosis Policy, Facility, for facility claims with dates of services on or after January 1, 2021.

Learn More
4th Quarter 2020 Preferred Drug List Updates- UnitedHealthcare Community Plans

Last Modified | 09.18.2020

UnitedHealthcare Community Plan’s Preferred Drug List (PDL) is updated quarterly by our Pharmacy and Therapeutics Committee. Please review the changes and update your references as necessary. The plan is for AZ, CA, HI, MD, NE, NV, NJ, NY, NY EPP, OH, PA CHIP, RI and VA.

Learn More
Developmental/Autism Screenings, Blood Lead Level Testing, Newborn Hearing Testing - UnitedHealthcare Community Plan of New York

Last Modified | 07.06.2020

Developmental, Autism Screenings, Blood Lead Level Testing, Newborn Hearing Testing, Early intervention, Standardized Developmental Screening Tools, Resources Pediatrics

Learn More
3rd Quarter 2020 Preferred Drug List Updates- UnitedHealthcare Community Plans

Last Modified | 06.15.2020

UnitedHealthcare Community Plan’s Preferred Drug List (PDL) is updated quarterly by our Pharmacy and Therapeutics Committee. Please review the changes and update your references as necessary. The plan is for AZ, CA, HI, MD, NE, NV, NJ, NY, NY EPP, OH, PA CHIP, RI and VA.

Learn More
Update to Procedure to Modifier Policy for “Always Therapy” Codes – Effective July 1, 2019 for UnitedHealthcare Community Plan of CA, HI, FL, LA, MD, MA, MI, MS, NE, NJ, NY, OH, PA, RI, WA, WI, VA

Last Modified | 05.14.2020

UnitedHealthcare Community Plan is updating its Procedure to Modifier Policy for claims for dates of service on or after July 1, 2019. Physical therapy (GP), occupational therapy (GO) or speech-language pathology (GN) modifiers will be required on “Always Therapy” codes to align with the Centers for Medicare & Medicaid Services (CMS).

Learn More
View More News

HEDIS Medical Record Collection

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. View our updated HIPAA information for UnitedHealthcare Community Plan.

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. View our policy.

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.