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July 2022Care Provider ManualPhysician, Health Care Professional, Facility and Ancillary1. PCA-1-016686-01122022Ohio RiseMedicaidUnitedHealthcare ConnectedDoc#: PMG 20220630 133418 06302022v63.10.2021
WelcomeWelcome to the UnitedHealthcare Community Planprovider manual. This up-to-date reference PDF manualallows you and your staff to find important informationsuch as how to process a claim and submit priorauthorization requests. This manual also includesimportant phone numbers and websites on the Howto Contact Us page. Find operational policy changesand other electronic transactions on our website atUHCprovider.com.Click the following links to access differentmanuals: UnitedHealthcare Administrative Guide forCommercial and Medicare Advantage memberinformation. Some states may also have MedicareAdvantage information in their Community Planmanual. A different Community Plan manual: go toUHCprovider.com/guides Community Plan CareProvider Manuals for Medicaid Plans by State FindYour State.Easily find information in this manual usingthe following steps:1. Select CTRL F.2. Type in the key word.3. Press Enter.If available, use the binoculars icon on the top right handside of the PDF to search for information and topics. Wegreatly appreciate your participation in our program andthe care you offer our members. If you have questions about the informationor material in this manual, or about ourpolicies, please call Provider Services.2 UnitedHealthcare Community Plan Ohio v 63.10.2021 Important informationabout the use of this manualIf there is a conflict between your Agreement and thiscare provider manual, use this manual unless yourAgreement states you should use it, instead. If there isa conflict between your Agreement, this manual andapplicable federal and state statutes and regulationsand/or state contracts, applicable federal and statestatutes and regulations and/or state contracts willcontrol. UnitedHealthcare Community Plan reservesthe right to supplement this manual to help ensure itsterms and conditions remain in compliance with relevantfederal and state statutes and regulations.This manual will be amended as policies change.Terms and definitions as used in this manual: “Member” or “customer” refers to a person eligibleand enrolled to receive coverage from a payer forcovered services as defined or referenced in yourAgreement. “You,” “your” or “provider” refers to any healthcare provider subject to this manual, includingphysicians, health care professionals, facilities andancillary providers; except when indicated andall items are applicable to all types of health careproviders subject to this guide. Community Plan refers to UnitedHealthcare’sMedicaid plan “Your Agreement,” “Provider Agreement” or“Agreement” refers to your Participation Agreementwith us. “Us,” “we” or “our” refers to UnitedHealthcareCommunity Plan on behalf of itself and its otheraffiliates for those products and services subject tothis manual. Any reference to “ID card” includes both a physicalor digital card. 2022 UnitedHealthcare
Table of Contents4Chapter 1: IntroductionChapter 2: Care Provider Standards and Policies16Chapter 3: Care Provider Office Procedures and Member Benefits26Chapter 4: Medical Management31Chapter 5: Early, Periodic Screening, Diagnostic and Treatment (EPSDT)/Prevention58Chapter 6: Value-Added Services62Chapter 7: Mental eHealth and Substance Use65Chapter 8: OhioRISE69Chapter 9: Member Rights and Responsibilities71Chapter 10: Medical Records74Chapter 11: Quality Management (QM) Program and Compliance Information78Chapter 12: Billing and Submission90Chapter 13: Claim Reconsiderations, Appeals and Grievances99Chapter 14: Care Provider Communications & Outreach109Chapter 15: Glossary1113 UnitedHealthcare Community Plan Ohio v 63.10.2021 2022 UnitedHealthcare
Chapter 1: IntroductionKey contactsTopicProvider ServicesTrainingProvider PortalCommunityCare Provider PortalTrainingProvider Portal SupportResource UHCprovider.com, then Sign In using your OneHealthcare ID or go to Provider Portal Self roviderself-service.htmlPhone Number800-600-9007New users: UHCprovider.com New User and UserAccessCommunityCare Provider Portal User Guideemail: ProviderTechSupport@uhc.comUHCprovider.com Resources Resource Library855-819-5909Looking for something else? In PDF view, click CTRL F, then type the keyword. In web view, type your keyword in the “what can we help you find?” search bar.UnitedHealthcare Community Plan supports the Ohiostate goals of increased access, improved healthoutcomes and reduced costs by offering benefits to thefollowing Medicaid members in every Ohio county.Ohio Medicaid covers members in the Covered Familiesand Children (CFC) program. This includes Healthy Startand Healthy Families, Foster Care, or the Aged, Blind,or Disabled (ABD) programs. CFC Medicaid consumersinclude families, children younger than age 19, andpregnant women. ABD Medicaid consumers includeadults age 65 and older and people who are blind ordisabled at any age.UnitedHealthcare Connected for MyCare Ohio servesmembers who are dually eligible for Medicare andMedicaid within the UnitedHealthcare Connected servicearea. UnitedHealthcare Connected members must beeligible and enrolled in Medicare Part A, Medicare PartB, and Ohio Medicaid.UnitedHealthcare Connected is available in Columbiana,Cuyahoga, Geauga, Lake, Lorain, Mahoning, Medina,Portage, Stark, Summit, Trumbull and Wayne Counties.4 UnitedHealthcare Community Plan Ohio v 63.10.2021 The Ohio Department of Medicaid (ODM) will determineenrollment eligibility.If you have questions about the informationin this manual or about our policies, go toUHCprovider.com or call ProviderServices at 800-600-9007.How to join our networkFor instructions on joining theUnitedHealthcare Community Planprovider network, go to UHCprovider.com/join. There you will find guidance onour credentialing process, how to sign upfor self-service and other helpfulinformation. 2022 UnitedHealthcare
Chapter 1: IntroductionAlready in network and need to make achange?To change an address, phone number, add or removephysicians from your TIN, or other changes, go to MyPractice Profile. Education and support with complex conditions. Tools for helping members engage with providers,such as appointment reminders and help withtransportation. Foundation to build trust and relationships with hardto-engage members.The Care Model program goals are to:Our approach to health care Lower avoidable admissions and unnecessaryemergency room (ER) visits, measured outcomes byinpatient (IP) admission and ER rates.Care Model Improve access to PCP and other needed services,measured by number of PCP visit rates withinidentified time frames.The Care Model program seeks to empowerUnitedHealthcare Community Plan members enrolledin Medicaid, care providers and our community toimprove care coordination and elevate outcomes.Targeting UnitedHealthcare Community Plan memberswith chronic complex conditions who often use healthcare, the program helps address their needs holistically.Care Model examines medical, behavioral and social/environmental concerns to help members get the rightcare from the right care provider in the right place and atthe right time.The program provides interventions to memberswith complex medical, behavioral, social, pharmacyand specialty needs, resulting in better quality of life,improved access to health care and reduced expenses.Care Model provides a care management/coordinationteam that helps increase member engagement, offersresources to fill gaps in care and develops personalizedhealth goals using evidence-based clinical guidelines.This approach is essential to improving the health andwell-being of the individuals, families and communitiesUnitedHealthcare Community Plan serves. Care Modelprovides: Market-specific care management encompassingmedical, behavioral and social care. An extended care team including primary careprovider (PCP), pharmacist, medical and behavioraldirector, and peer specialist. Options that engage members, connecting them toneeded resources, care and services. Individualized and multidisciplinary care plans. Assistance with appointments with PCP andcoordinating appointments. The Clinical HealthAdvocate (CHA) refers members to an RN,Behavioral Health Advocate (BHA) or otherspecialists as required for complex needs.5 UnitedHealthcare Community Plan Ohio v 63.10.2021 Identify and discuss behavioral health (BH) needs,measured by number of behavioral health careprovider visits within identified time frames. Improve access to pharmacy. Identify and remove social and environmentalbarriers to care. Improve health outcomes, measured by improvedHealthcare Effectiveness Data and Information Set(HEDIS ) and Centers for Medicare & MedicaidServices (CMS) Star Ratings metrics. Empower the member to manage their complex/chronic illness or problem and care transitions. Improve coordination of care through dedicated staffresources and to meet unique needs. Engage community care and care provider networksto help ensure access to affordable care and theappropriate use of services.To refer your patient who is aUnitedHealthcare Community Planmember to the Care Model program, callMember Services at Medicaid: 800-8952017 Relay 711 (TTY) or MyCare: 877-5429236 (TTY 711) . You may also callProvider Services at 800-600-9007.ComplianceHIPAA 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 careproviders who handle business electronically. 2022 UnitedHealthcare
Chapter 1: IntroductionCultural resourcesElectronic Data Interchange (EDI)To help you meet membership needs, UnitedHealthcareCommunity Plan has developed a Cultural CompetencyProgram. Linguistic and cultural barriers can negativelyaffect access to health care participation.You mustsupport UnitedHealthcare Community Plan’s CulturalCompetency Program.EDI is an online resource using your internal practicemanagement or hospital information system to exchangetransactions with us through a clearinghouse.UnitedHealthcare Community Plan offers the followingsupport services: Language Interpretation Line: We provide oralinterpreter services 24 hours a day, seven days aweek to our members free of charge. More than 240non-English languages and hearing impaired servicesare available. If a UnitedHealthcare CommunityPlan member needs interpreter services, they cancall the phone number on their ID card. To accessa professional interpreter during regular businesshours, call Member Services. Materials for limited English speaking members:We provide simplified materials for memberswith limited English proficiency and who speaklanguages other than English or Spanish. We alsoprovide materials for visually impaired members.For more information, go to uhc.com LanguageAssistance.Evidence-based clinicalreview criteria andguidelinesUnitedHealthcare Community Plan uses Interqual(We formerly used MCG Guidelines.) for medical caredeterminations.Online resourcesUHCprovider.com is your home for care providerinformation with access to Electronic Data Interchange(EDI), Provider Portal online services, medical policies,news bulletins. It also includes great resources tosupport administrative tasks such as eligibility, claims,claims status and prior authorizations and notifications.Go to Self Service for Self Service Tool online trainingand information.6 UnitedHealthcare Community Plan Ohio v 63.10.2021 The benefit of using EDI is it permits care providersto send batch transactions for multiple members andmultiple payers in lieu of logging into different payerwebsites to manually request information. This is whyEDI is usually care providers’ and UnitedHealthcareCommunity Plan’s first choice for electronic transactions. Send and receive information faster Identify submission errors immediately and avoidprocessing delays Exchange information with multiple payers Reduce paper, postal costs and mail time Cut administrative expenses EDI transactions available to care providers are:- Claims (837),- Eligibility and benefits (270/271),- Claims status (276/277),- Referrals and authorizations (278),- Hospital admission notifications (278N), and- Electronic remittance advice (ERA/835).Visit UHCprovider.com/EDI for more information. Learnhow to optimize your use of EDI at UHCprovider.com/optimizeEDI.Getting started If you have a practice management or hospitalinformation system, contact your software vendor forinstructions on how to use EDI in your system. Contact clearinghouses to review which electronictransactions can interact with your software system.Read our Clearinghouse Options page for moreinformation.Provider Portal- secure care provider websiteThe Provider Portal provides a secure online portal tosupport your administrative tasks including eligibility,claims and prior authorization and notifications. Tosign in to the portal, go to UHCprovider.com and clickSign In on the upper right corner. For more informationabout all online services, go to Self Service Toolsand Eligibility or go to the Provider Portal Self Service 2022 UnitedHealthcare
Chapter 1: Introductionpage at elf-service.html.For Provider Portal training, go to Community CareProvider Portal User Guide. o access the Provider Portal, the secureTcare provider website, go toUHCprovider.com and either sign in orcreate a user ID. You will receive youruser ID and password within 48 hours.The secure care provider website lets you: Verify member eligibility including secondarycoverage.5reasonsto useUHCprovider.com1Provider PortalUse self-service to verifyeligibility and claims, requestprior authorization, providenotifications and accessDocument Library.Click “Sign In” in the top rightcorner of UHCprovider.com Review benefits and coverage limits. Check prior authorization status. Access remittance advice and review recoveries. Review your preventive health measure report. Access the Early and Periodic Screening, Diagnosis,and Treatment (EPSDT) toolset.PriorAuthorizationand Notification Search for CPT codes. Type the CPT code in theheader search box titled “What can I help you find?”on UHCprovider.com, and the search results willdisplay all documents and/or web pages containingthat code. Find certain web pages more quickly usingdirect URLs. You’ll see changes in the way wedirect you to specific web pages on ourUHCprovider.com provider portal. You can nowuse certain direct URLs, which helps you find andremember specific web pages easily and quickly.You can access our most used and popular webpages on UHCprovider.com by typing in that page’sdirect URL identified by a forward slash in the webaddress, e.g. UHCprovider.com/claims. When yousee that forward slash in our web links, you cancopy the direct URL into your web page address barto quickly access that page.You will conduct business with us electronically. Usingelectronic transactions is fast, efficient, and supportsa paperless work environment. Use both EDI andUnitedHealthcare Provider Portal for maximum efficiencyin conducting business electronically.To access the Provider Portal, go to UHCprovider.com, then Sign In.7 UnitedHealthcare Community Plan Ohio v 63.10.2021 23UHCprovider.com/paanSend batch transactionsfor multiple members andpayers from one place,review claims and onnect5Policiesand ProtocolsRequest approval forprescriptions, admissionsand procedures.Communicate securelywith payers to addresserrant claims. Emaildirectconnectsupport@optum.com to get started.Review guidelines thatapply to UnitedHealthcareCommunity Plan andhow you care for ourmembers.UHCprovider.com/policiesFind more information about these online services and moreat UHCprovider.com – your hub for online transactions,education and member benefit information. 2022 UnitedHealthcare
Chapter 1: IntroductionHere are the most frequently used transactions on theProvider Portal: Eligibility and Benefits — View patient eligibility andbenefits information for most benefit plans. For moreinformation, go to UHCprovider.com/eligibility. Claims — Get claims information for manyUnitedHealthcare plans, including access letters,remittance advice documents and reimbursementpolicies. For more information, go to UHCprovider.com/claims. Prior Authorization and Notification — Submitnotification and prior authorization requests. Formore information, go to UHCprovider.com/paan. Specialty Pharmacy Transactions — Submitnotification and prior authorization requests forcertain medical injectable specialty drugs. Go toUHCprovider.com/pharmacy for more information. My Practice Profile — View and update yourprovider demographic data that UnitedHealthcaremembers see for your practice. For moreinformation, go to UHCprovider.com/mypracticeprofile. Document Library — Access reports and claimletters for viewing, printing, or download. TheDocument Library Roster provides member contactinformation in a PDF, and can only be pulled at theindividual practitioner level. For more information, goto UHCprovider.com/documentlibrary. Paperless Delivery Options — The PaperlessDelivery Options tool can send daily or weekly emailnotifications to alert you to new letters when we addthem to your Document Library. With our deliveryoptions, you decide when and where the emailsare sent for each type of letter. This is available toProvider Portal One Healthcare ID password ownersonly.Watch for the most current information on our selfservice resources by email, in the Network Bulletin, oronline at UHCprovider.com/EDI or the Provider Portalat UHCprovider.com then click Sign In.*For more instructions, visit UHCprovider.com/Trainingor Self Service Tools for online self- service training andinformation.Direct Connectclaims. This portal can replace previous methods ofletters, faxes, phone calls and spreadsheets. It alsohelps: Manage overpayments in a controlled process. Create a transparent view between care providerand payer. Avoid duplicate recoupment and returned checks. Decrease resolution timeframes. Real-time reporting to track statuses of inventories inresolution process. Provide control over financial resolution methods.All users will access Direct Connect using the ProviderPortal. On-site and online training is available.Email directconnectsupport@optum.comto get started with Direct Connect.PrivilegesTo help our members access appropriate care andminimize out-of-pocket costs, you must have privilegesat applicable in-network facilities or arrangements withan in-network provider to admit and provide facilityservices. This includes full admitting hospital privileges,ambulatory surgery center privileges and/or dialysiscenter privileges.Provider ServicesProvider Services is the primary contact for careproviders who require assistance. It is staffed withrepresentatives trained specifically for UnitedHealthcareCommunity Plan.Provider Services can assist you withquestions on Medicaid benefits, eligibility,claim decision, forms required to reportspecific services, billing questions andmore.Provider Services works closely with all departments inUnitedHealthcare Community Plan.Direct Connect is a free online portal that lets yousecurely communicate with payers to address errant8 UnitedHealthcare Community Plan Ohio v 63.10.2021 2022 UnitedHealthcare
Chapter 1: IntroductionHow to contact us*We no longer use fax numbers for most departments,including benefits, prior authorization and claims.TopicContactInformationBehavioral HealthOptum providerexpress.comEligibility, claims, benefits, authorization andappeals.providerexpress.comBenefits866-209-9320 (toll-free)Refer members for behavioral health services. APCP referral is not required.UHCprovider.com/benefitsConfirm a member’s benefits and/or priorauthorization.800-600-9007Cardiology PriorAuthorizationFor prior authorization or a currentlist of CPT codes that require priorauthorization, visit UHCprovider.com/cardiologyReview or request prior authorization, see basicrequirements, guidelines, CPT code list, andmore information.Medicaid: 866-604-3267MyCare: 800-366-7304Care ManagementMedical Care Management Services: 800508-2581 (Medicaid)Call Monday through Friday, 8 a.m. to 5 p.m.,Eastern Time.Behavioral Health Care Management:Call 24 hours a day, 7 days a week for help withwith referrals, prior authorizations, admissions,discharges and coordination of members’ care.866-261-7692Care Model r high-risk members (e.g., asthma, diabetes,obesity) and members who need private-dutynursing.Chiropractor Caremyoptumhealthphysicalhealth.comWe provide members older than 21 with up tosix visits per calendar year with an in-networkchiropractor. This benefit does not need priorauthorization.800-873-45759 UnitedHealthcare Community Plan Ohio v 63.10.2021 2022 UnitedHealthcare
Chapter 1: IntroductionTopicContactInformationClaimsUse the Link Provider Portal atUHCprovider.com/claimsVerify a claim status or get information aboutproper completion or submission of claims.800-600-9007Mailing address:UnitedHealthcare Community PlanP.O. Box 8207Kingston, NY 12402ClaimOverpaymentsSee the Overpayment section forrequirements before sending yourrequest.Ask about claim overpayments.Sign in toUHCprovider.com/claims to accessthe Provider Portal, then select theUnitedHealthcare Online app800-600-9007Mailing address:UnitedHealthcare Community PlanATTN: Recovery ServicesP.O. Box 740804Atlanta, GA 30374-0800Dental ServicesDentaQuest 800-341-8478Call DentaQuest to find a network provider.Electronic DataIntake Claim Issuesac edi ops@uhc.comAsk about claims issues or questions.800-210-8315Electronic Data800-842-1109Intake Log-on IssuesInformation is also available atUHCprovider.com/edi.EligibilityConfirm member eligibility online or call our tollfree Interactive Voice Response (IVR) system 24hours a day, 7 days a week.To access eligibility information, go toUHCprovider.com, then Sign In to theProvider Portal or go toUHCprovider.com/eligibilityInteractive Voice Response 888-586-4766Enterprise VoicePortal877-842-321010 UnitedHealthcare Community Plan Ohio v 63.10.2021 The Enterprise Voice Portal provides self-servicefunctionality or call steering prior to speaking witha contact center agent. 2022 UnitedHealthcare
Chapter 1: IntroductionTopicContactInformationFraud, Waste andAbuse (PaymentIntegrity)Payment Integrity Information:Learn about our payment integrity policies.UHCprovider.com/OHcommunityplan Integrity of Claims, Reports, andRepresentations to the GovernmentReport suspected FWA by a care provider ormember by phone or online.Reporting: uhc.com/fraudtipform-ui-optum.comFWA Hotline: 866-242-7727Healthy First Steps/Obstetrics (OB)Referral800-599-5985Refer pregnant members to this program.Laboratory ServicesUHCprovider.com Our Network Preferred Lab NetworkLabCorp and Quest Diagnostics are networklaboratories.LabCorp 800-833-3984Quest Diagnostics questdiagnostics.comMedicaid (OhioDepartment ofMedicaid)medicaid.ohio.govMedical Claim,Reconsiderationand AppealSign in to the Provider Portal atUHCprovider.com or go toUHCprovider.com/claimsContact Medicaid directly.800-324-8680800-600-9007Claim issues include overpayment,underpayment, payment denial, or an original orcorrected claim determination you don’t agreewith.Reconsiderations mailing address:UnitedHealthcare Community PlanP.O. Box 8207Kingston, NY 12402-5240Appeals mailing address:UnitedHealthcare Community PlanGrievances and AppealsP.O. Box 31364Salt Lake City, UT 84131-0364Member ServicesMedicaid: 800-895-2017 Relay 711 (TTY)Assist members with issues or concerns.MyCare: 877-542-9236 (TTY 711)Medicaid: 7 a.m. – 7 p.m. Central Time, Mondaythrough Friday.MyCare: 8 a.m. – 8 p.m. Eastern Time, Mondaythrough Friday. Voicemail available 24 hours aday, seven days a week.Mental Health &Substance Use(Behavioral Health)866-261-769211 UnitedHealthcare Community Plan Ohio v 63.10.2021 Refer members for behavioral health services. (APCP referral is not required.)*See Behavioral Health row for more information. 2022 UnitedHealthcare
Chapter 1: lecommunicationAssistanceMember ServicesMedicaid: 7 a.m. – 7 p.m. Central Time, Mondaythrough Friday.MyCare: 877-542-9236 (TTY 711)MyCare: 8 a.m. – 8 p.m. Eastern Time, Mondaythrough Friday. Voicemail available 24 hours aday, seven days a week.National Planand ProviderEnumerationSystem (NPPES)nppes.cms.hhs.govApply for a National Provider Identifier (NPI).NetworkManagementResource Team(NMRT)877-842-3210Self-service functionality to update or checkcredentialing information.NetworkManagement Team800-600-9007This is the provider relations team. Ask aboutcontracting and care provider services.NurseLine800-542-8630Available 24 hours a day, seven days a week.Obstetrics and BabyCareHealthy First StepsFor pregnant members, contact HealthyFirst Steps by calling or filling out the onlinePregnancy Notification Form.Medicaid: 800-895-2017 Relay 711 (TTY)800-465-3203Pregnancy Notification Form atUHCprovider.com, then Sign In for theProvider Portal.800-599-5985Refer members to UHChealthyfirststeps.com tosign up for Healthy First Steps Rewards.Healthy First Steps RewardsUHChealthyfirststeps.comOncology PriorAuthorizationUHCprovider.com Prior Authorization OncologyFor current list of CPT codes that require priorauthorization for oncologyOptum 888-397-8129 Monday -Friday 7am– 7pm CSTOne Healthcare IDSupport Centeremail: ProviderTechSupport@uhc.comPharmacy 05-8952 (OptumRx)Contact if you have issues with your ID. Available7 a.m. – 9 p.m. Central Time, Monday throughFriday; 6 a.m. – 6 p.m. Central Time, Saturday;and 9 a.m. – 6 p.m. Central Time, Sunday.OptumRx oversees and manages our networkpharmacies.Technical Help Desk (pharmacies call):877-305-895212 UnitedHealthcare Community Plan Ohio v 63.10.2021 2022 UnitedHealthcare
Chapter 1: IntroductionTopicContactInformationPrior Authorization/Notification forPharmacyUHCprovider.com Prior Authorizationand Notification Clinical Pharmacy andSpecialty DrugsRequest authorization for medications asrequired.Provider Pharmacy Prior AuthorizationHelp Desk: 800-310-6826Use the Provider Portal to access the PreCheckMyScript tool. Request prior authorization andreceive results, and see which prescriptionsrequire prior authorization or are not covered orpreferred Check coverage and price, includinglower-cost alternatives.To notify us or request a medical priorauthorization:Use the Prior Authorization and Notification Toolonline to:Medicaid: 800-310-6826MyCare: 800-711-4555Prior EDI: Transactions 278 and 278NOnline Tool: UHCprovider.com/paanPhone: Call Care Coordination at thenumber on the member’s ID card (selfservice available after hours) and select“Care Notifications.” or callMedicaid: 866-604-3267MyCare: 800-366-7304Provider 7 Determine if notification or prior authorizationis required. Complete the notification or priorauthorization process. Upload medical notes or attachments. Check request statusVisit UHCprovider.com/OHcommunityplan PriorAuthorization and NotificationAvailable 8 a.m. – 5 p.m. Central Time, Mondaythrough Friday.UnitedHealthcare Community Plan9200 Worthington Road, 3rd FloorWorthington, OH 43082Radiology lsUHCprovider.com Referrals866-889-8054or use Referrals on the Provider Portal.Click Sign in at the top right corner ofUHCprovider.com, then click Referrals.Review or request prior authorization, see basicrequirements, guidelines, CPT code list, andmore information.Submit new referral requests and check thestatus of referral submissions.Provider Services 800-600-900713 UnitedHealthcare Community Plan Ohio v 63.10.2021 2022 UnitedHealthcare
Chapter 1: licyUHCprovider.com/OHcommunityplan Policies and Clinical GuidelinesReimbursement policies that apply toUnitedHealthcare Community Plan members.Visit this site often to view reimbursement policyupdates.Technical SupportwebsiteCall this number if you have issues logging in tothe Provider Portal, you cannot submit a tance866-209-9320 for Optum support or 866842-3278, Option 1 for web supportemail: ProviderTechSupport@uhc.comTobacco Free QuitLine800-784-8669Ask about services for quitting tobacco/smoking.TransportationModivCare 800-269-4190Call ModivCare or Member Services to scheduletransportation or transportation assistancethrough ModivCare. To arrange non-urgenttransportation, please call two business days inadvance.UtilizationManagement800-366-7304UM helps avoid overuse and under-use ofmedical services by making clinical coveragedecisions based on available evidence-basedguidelines.Request a copy of our UM guidelines orinformation about the program. For UM policiesand protocols, go to UHCprovider.com Resources Plans, Policies, Protocols andGuides.Vaccines forChildren 800-282-054614 UnitedHealthcare Community Plan Ohio v 63.10.2021 Care providers must participate in the VFCProgram administered by the Department ofHealth and Senior Services (DHSS) and mustuse the free vaccine when administering vaccineto qualified eligible children. Providers mustenroll as VFC providers with DHSS to bill for theadmin
Topic Link Phone Number Provider Services UHCprovider.com 800-600-9007 . Healthcare Effectiveness Data and Information Set (HEDIS ) and Centers for Medicare & Medicaid . UnitedHealthcare Community Plan member to the Care Model program, call Member Services at Medicaid: 800-895-2017 Relay 711 (TTY) or MyCare: 877-542- .
