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Alert for Providers

*  Attention Florida Healthy Kids Providers  *

Important notice: Starting Jan. 1, 2020, there will be changes to Florida Healthy Kids health plans throughout the state. As a result of these changes, our contract with Florida Healthy Kids will expire on Dec. 31, 2019.

Click on this link for more information.

* Alert to Medicaid and Long Term Care Home Care Providers*

Electronic Visit Verification (EVV) has been implemented: Effective 9/01/2019
Applies to Home Health Care, Private Duty Nursing, and Homemaker Companion
Go to 4Tellus.com for more information and to register.
Additional contacts: Provider Advocate or fl_ltc_network@uhc.com or 407-659-7241 

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

DUR Educational Newsletter: Safety in Respiratory Therapy - UnitedHealthcare Community Plan

Last Modified | 02.12.2020

The National Asthma Education and Prevention Program (NAEPP) published guidelines for the treatment of asthma in2007.¹ The guidelines outline goals of therapy that include the prevention of recurrent exacerbation and need for emergencydepartment or hospital care, the prevention of reduced lung growth in children or loss of lung function in adults, and theoptimization of pharmacotherapy with minimal or no adverse effects.

Learn More
Site of Service Reviews for Surgical Procedures – Code List Change - UnitedHealthcare Community Plan

Last Modified | 02.03.2020

We recently announced the expansion of our notification/prior authorization requirements and site of service medical necessity reviews to include certain surgical codes. This announcement is an update to the original announcements.

Learn More
Healthy Kids Contract Update - UnitedHealthcare Community Plan of Florida

Last Modified | 02.04.2020

Starting Jan. 1, 2020, there will be changes to Florida Healthy Kids health plans throughout the state. As a result of these changes, our contract with Florida Healthy Kids will expire on Dec. 31, 2019.

Learn More
Treating Atopic Dermatitis - UnitedHealthcare Community Plan of Florida

Last Modified | 11.12.2019

In dontinuing focus on safe, high-quality and cost-effective care, we're providing this fact sheet as a resource for care providers who are treating patients with atopic dermatitis (AD).

Learn More
Support for Florida Residents Affected by Hurricane Dorian

Last Modified | 09.10.2019

UnitedHealthcare is taking the following actions to help those who may be affected by Hurricane Dorian.

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.

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.