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For UnitedHealthcare Community Plan of Florida

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UnitedHealthcare Community Plan of Florida Homepage

ATTENTION NEW PROVIDERS!

UnitedHealthcare welcomes new providers to the Florida Comprehensive (MMA and LTC) health plan. We want you to know that as a new provider you will continue to receive payment for covered services rendered to our members, without a prior authorization needed, during the 60 day continuity of care period. Our provider services team can assist you with any questions you have at 877-842-3210.

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.

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

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.

Helpful Resources

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

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

New! Diabetic Supply Changes - UnitedHealthcare Community Plan of Florida

Last Modified | 06.24.2019

We recently chose BD as the preferred manufacturer for insulin syringes and pen needles for your patients who are UnitedHealthcare Community Plan members.

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

Last Modified | 06.24.2019

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).

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Site of Care and Prior Authorization Updates For Speech, Occupational and Physical Therapy Services

Last Modified | 06.21.2019

Site of Care and Prior Authorization Updates For Speech, Occupational and Physical Therapy Services

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Site of Care for Certain Therapy Services: UnitedHealthcare Community Plan of Florida Frequently Asked Questions

Last Modified | 06.21.2019

We currently require prior authorization for all speech, occupational, and physical therapy services. As part of our efforts toward the Triple Aim of improving health care services, health outcomes and cost of care, beginning May 13, 2019, once prior authorization for these therapy services is requested in accordance with our prior authorization requirements, we’ll determine whether the site of care is medically necessary, including cost effective, consistent with Florida’s Agency for Health Care Administration (AHCA) definition of medical necessity. Site of care reviews will be conducted only if the service will be performed in an outpatient hospital.

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Long-Acting Reversible Contraceptives: Billing and Reimbursement - UnitedHealthcare Community Plan of Florida

Last Modified | 06.12.2019

Long-acting reversible contraception (LARC) devices are eligible for reimbursement when billed in conjunction with Labor/Delivery services.

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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.

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.