The UnitedHealthcare Community Plan is managed by UnitedHealthcare Insurance Company, which has a membership of 40 million people. The plan provides low-cost medical coverage to Medicaid and Medicare Advantage recipients and is one of the largest providers of Medicaid coverage to states in the U.S. The Medicare Advantage plans combine the benefits of Original Medicare with additional features while allowing recipients to use their Medicaid benefits.
UnitedHealthcare Community Plan options are available in Arizona, Delaware, Florida, Hawaii, Iowa, Kansas, Louisiana, Maryland, Massachusetts, Michigan, Mississippi, Nebraska, Nevada, New Jersey, New Mexico, New York, Ohio, Pennsylvania, Rhode Island, Tennessee, Texas, Washington, and Wisconsin. Network size differs from state to state. For example, in New York the plan serves 43 counties through 235 hospitals and over 65,000 doctors.
UnitedHealthcare Community Plan partners with local communities to improve health awareness for women and children. The company helps educate the elderly on health programs they can access and participates in the Farm to Fork Program in Mississippi to help encourage healthy eating habits. UnitedHealthcare Community Plan also helps local communities obtain grants.
Like many insurance companies, UnitedHealthcare Community Plan’s product offerings include HMO plans.
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Taxonomy code and requirements for Florida Medicaid claims
As of March 1, 2022, the Agency for Health Care Administration (AHCA) requires billing and rendering providers to include the following information on your claims. Ensure your information matches the current provider enrollment information on file with AHCA or your claims will deny beginning Oct. 1, 2022.
Welcome to the Home for Care Provider Resources
For UnitedHealthcare Community Plan of Florida
Welcome
For UnitedHealthcare Community Plan of Florida
Welcome to the Home for Care Provider Resources
For UnitedHealthcare Community Plan of Florida
Welcome
For UnitedHealthcare Community Plan of Florida
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
Find Local COVID-19 Diagnostic Testing Locations
Use these online tools to help find your patients find a COVID-19 diagnostic testing location:
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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.
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/FL for current plan names, overview of eligibility information, doctor look up and more.
Member Health Waivers
If you are a provider of a member whose health was previously cared for under one of the following waivers, please contact Provider Services for extra help understanding your full benefit program:
- Project Aids Care (PAC) Waiver
- Traumatic Brain Injury (TBI) or Spinal Cord Injury (SCI) Waiver
- Adult Cystic Fibrosis (ACF) Waiver
You can reach our Provider Services team by calling the number on the back of your members ID card, or by referencing the contact numbers below:
- Managed Medical Assistance (MMA): 877-842-3210
- Long Term Care (LTC): 800-791-9233
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: For help using CommunityCare feature on the UnitedHealthcare Provider Portal, please see our Quick Reference Guide. If you’re not familiar with UnitedHealthcare Provider Portal, go to UHCprovider.com/portal.CommunityCare
Need to make a change to your provider or facility directory information?
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
Last Modified | 10.24.2022
The Agency for Health Care Administration requires Medicaid providers to sign a wage increase agreement by Oct. 1, 2022.
Learn More
Last Modified | 09.23.2022
As of March 1, 2022, the Agency for Health Care Administration requires billing and rendering providers to include certain identifying information on your claims. Ensure your information matches the current provider enrollment information on file with AHCA or your claims will deny beginning Oct. 1, 2022.
Learn More
Last Modified | 05.16.2022
Health care professionals who wish to contract with UnitedHealthcare Community Plan may need a site visit as part of the credentialing process.
Learn More
Last Modified | 04.29.2022
Effective Aug. 1, 2022, Optum will manage prior authorization requests for non-oncology injectable medications that are covered on the medical benefit for UnitedHealthcare Community Plans.
Learn More
Last Modified | 01.27.2022
Free on-demand CMEs: Buprenorphine and pregnancy Help reduce rates of Neonatal Abstinence Syndrome (NAS) and improve birth outcomes.
Learn More
View More News
Resources:
- SMMC Resource Guide - This reference guide provides a list of the departments at UnitedHealthcare that may be helpful in assisting with coordination and authorization of services that a member may need.
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.
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.