Welcome to the Home for Care Provider Resources

For UnitedHealthcare Community Plan of Washington


For UnitedHealthcare Community Plan of Washington

UnitedHealthcare Community Plan of Washington 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


The University of Washington’s Collaborative Care Model is an integrated, evidence-based approach that aims to bring together primary care providers and behavioral health care providers to deliver care to eligible members. The Collaborative Care Model gives the PCP access to additional care management support and regular psychiatric consultation for members receiving behavioral health treatment. The Washington State Health Care Authority and UnitedHealthcare Community Plan are encouraging care providers to learn more about how they may integrate this model into their practice.

Interested? The first step is to submit an attestation – Washington State Health Care Authority form 13- 0017 – to become an approved collaborative care provider for UnitedHealthcare Community Plan members. Email the form to us at WAcollaborativecare@uhc.com. After that, one of our Transformation Advocates will contact you.

Helpful Resources 

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

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


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.

Helpful Resources

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

Plan information is available for:

  • UnitedHealthcare Community Plan of Washington - Apple Health

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

The Partnership Access Line (PAL) is a mental health consultation resource available to all primary care providers to help practices deliver more effective mental health care for any child they see, regardless of insurance. PAL also includes PAL for Moms, which is focused on support for postpartum depression.   Learn more about PAL and upcoming care provider training on the Seattle Children’s website, seattlechildrens.org/PAL.

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.  

Current News, Bulletins and Alerts

Expanded Community Plan Notification/Prior Authorization Requirements and Site of Service Medical Necessity Reviews for Certain Surgical Procedures – Effective Nov. 1, 2019 for MD, RI, WA, MI, MO, OH

Last Modified | 09.30.2019

We’ve been focused on helping to work toward achieving better health outcomes, improving patient experience and lowering the cost of care. To continue this important work, our newly expanded prior authorization requirement may help to improve cost efficiencies for the overall health care system, while still providing access to safe, quality health care.

Learn More
New Respiratory Viral Panel Testing Professional and Facility Reimbursement Policy for UnitedHealthcare Community Plan of Washington

Last Modified | 09.30.2019

UnitedHealthcare Community Plan is implementing a new Respiratory Virus Panel Testing Reimbursement Policy for professional and facility claims with dates of services on or after Dec. 1, 2019.

Learn More
Reimbursement Notice for Evaluation and Management Services Performed During for UnitedHealthcare Community Plan of AZ, CA, HI, KS, MA, MI, MO, NJ, NY, VA, WA, and WI

Last Modified | 09.20.2019

We’re letting you know about an issue with our Obstetrical Services Professional Reimbursement Policy. When it comes to evaluation and management services performed during global obstetrical care, UnitedHealthcare Community Plan allows up to three evaluation and management services in addition to the global obstetrical package, depending on state regulations, when billed with a pregnancy-related diagnosis.

Learn More
Hepatitis A Outbreak Alert for Community Clinics and Pharmacies - UnitedHealthcare Community Plan of Washington

Last Modified | 09.17.2019

Washington State Department of Health (DOH) announced an outbreak of hepatitis A (HAV) withinWashington state on July 30, 2019. Multiple states across the country have reported outbreaks of HAV,primarily among persons experiencing homelessness and persons who use drugs.

Learn More
DUR Educational Newsletter: Opioid and Buprenorphine Use for Treating Opioid Use Disorder

Last Modified | 08.16.2019

Buprenorphine and full opioid agonists should not be used together to treat opioid use disorder.

Learn More
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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.


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.