UnitedHealthcare Community Plan provides benefits and service to members, including:
• TANF – Temporary Assistance for Needy Families
• CHIP – Children’s Health Insurance Program
• AABD – Assistance to the Aged, Blind, and Disabled
• LTC – Long-term Care
• DSNP – Dual Special Needs Plan
For instructions on joining the UnitedHealthcare Community Plan provider network, go to UHCProvider.com. There you will find guidance on our credentialing process, how to sign up for self-service tools and other helpful information.
The Whole Person Care (WPC) program seeks to empower UnitedHealthcare Community Plan members enrolled in Medicaid, care providers and our community partners to improve care coordination and elevate outcomes. Targeting UnitedHealthcare Community Plan members with chronic complex conditions who often use health care, the program helps address their needs holistically. WPC examines medical, behavioral and social/environmental concerns to help members get the right care from the right care provider in the right place and at the right time.
The program provides interventions to members with complex medical, behavioral, social, pharmacy and specialty needs, resulting in better quality of life, improved access to health care and reduced expenses. WPC provides a care management/coordination team that helps increase member engagement, offers resources to fill gaps in care and develops personalized health goals using evidence-based clinical guidelines. This approach is essential to improving the health and well-being of the individuals, families and communities UnitedHealthcare Community Plan serves. WPC provides:
The goals of the WPC program are to:
To refer your patient who is a UnitedHealthcare Community Plan member to WPC, call Provider Services at 888-980-8728.
UHCprovider.com is your home for care provider information with access to Electronic Data Interchange (EDI), Link self-service tools, medical policies, news bulletins, and great resources to support administrative tasks including eligibility, claims, claims status and prior authorizations and notifications.
EDI is a self-service resource using your internal practice management or hospital information system to exchange transactions with us through a clearinghouse. The benefit of using EDI is it permits care providers to send batch transactions for multiple members and multiple payers in lieu of logging into different payer websites to manually request information. This is why EDI is usually care providers’ first choice for electronic transactions.
Read our Clearinghouse Options page for more information.
Link provides a secure online portal to support your administrative tasks including eligibility, claims and prior authorization and notifications. To sign in to Link, go to UHCprovider.com and click on the Link button in the upper right corner. For more information about all Link tools, go to UHCprovider.com/Link.
To access Link, the secure care provider website, go to UHCprovider.com and either sign in or create a user ID for Link. You will receive your user ID and password within 48 hours.
The secure care provider website lets you:
Here are most frequently used tools:
* For more instructions, visit UHCprovider.com/Training.
Direct Connect is a free online portal that lets you securely communicate with payers to address errant claims. This portal has the ability to replace previous methods of letters, faxes, phone calls and spreadsheets. It also helps:
All users will access Direct Connect using Link. On-site and online training is available.
Email firstname.lastname@example.org to get started with Direct Connect.
To help you meet membership needs, UnitedHealthcare Community Plan has developed a Cultural Competency Program. Linguistic and cultural barriers can negatively affect access to health care participation. You must help UnitedHealthcare Community Plan meet this obligation for our members.
UnitedHealthcare Community Plan offers the following support services:
Within UnitedHealthcare Community Plan, the Network Management Department can help you with your contract, credentialing and in-network services. The department has network account managers and provider advocates who are available for visits, contracting, credentialing and other related issues.
If you need to speak with a network contract manager about credentialing or contracting, email our Network Management Team at Hawaii_PA_Team@uhc.com.
Provider Services is the primary contact for care providers who require assistance. It is staffed with representatives trained specifically for UnitedHealthcare Community Plan.
Provider Services can assist you with questions on Medicaid benefits, eligibility, claim decision, forms required to report specific services, billing questions and more.
Provider Services works closely with all departments in UnitedHealthcare Community Plan.
This includes full admitting hospital privileges, ambulatory surgery center privileges and/or dialysis center privileges.
Many cultures engage in traditional health practices such as holistic medicine, acupuncture, medicinal herbs, meditation, spiritual counseling, therapeutic massage or martial arts.
When developing a treatment plan for members, consider:
Acknowledging the member’s choice for consultation of spiritual or traditional practitioners in addition to prescribing more western forms of treatment
HIPAA mandates National Provider Identifier (NPI) usage in all standard transactions (claims, eligibility, remittance advice, claims status request/response, and authorization request/response) for all health care providers who handle business electronically.
UnitedHealthcare Community Plan uses MCG Care Guidelines (formally Milliman Care Guidelines) for medical care determinations.