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For UnitedHealthcare Community Plan of Pennsylvania

Welcome to the Home for Pennsylvania Community Plan Care Provider Resources

For UnitedHealthcare Community Plan of Pennsylvania

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UnitedHealthcare Community Plan of Pennsylvania 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.

Provider Call Center

800-600-9007, Monday-Friday, 8 a.m. – 5 p.m.

Postal Mailing Address

UnitedHealthcare Community Plan
2 Allegheny Center Suite 600
Pittsburgh, PA 15212

Claims Mailing Address

UnitedHealthcare Community Plan
PO Box 8207
Kingston, NY 12402-8207

Utilization Management Appeals Address 

UnitedHealthcare Community Plan
Attn: Grievances and Appeals
PO Box 31364
Salt Lake City, UT 84131-0364

Claims Appeals Mailing Address

Part C Appeals and Grievance Department
UnitedHealthcare Community Plan
Attn: Complaint and Appeals Department
P.O. Box 31364
Salt Lake City, UT 84131-0364
 
Part D Appeals and Grievance Department
Attn: CA124-0197
P.O. Box 6106
Cypress, CA 90630-9948

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

Need to make a change to your provider or facility directory information? 

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/PA for current member plan information including sample member ID cards, provider directories, dental plans, vision plans and more.

Plan information is available for:

  • Pennsylvania UnitedHealthcare Community Plan for Families
  • Pennsylvania UnitedHealthcare Community Plan for Kids

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

Need to make a change to your provider or facility directory information? 

Forms for Medical Assistance members are available from the Pennsylvania Department of Human Services website. Most forms are available in both English and Spanish. Available forms include:

  • Abortion Consent Form
  • Eligibility Determination Form
  • Hysterectomy Consent Form
  • Medical Assistance Provider Order Form
  • Medical Evaluation Plan of Care Form
  • Newborn Eligibility Form
  • Obstetrical Needs Assessment Form
  • Outpatient Services Authorization Request Form
  • Recipient Statement Forms
  • Service Coordination Plan
  • Sterilization Consent Form

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.  

UnitedHealthcare Community Plan offers a Special Needs Unit (SNU) to help members who have special needs because of on-going physical, developmental, emotional or behavioral conditions.

If you have a UnitedHealthcare Community Plan patient who has a special need, please consider calling or having your patient call the Special Needs Unit at 877-844-8844 or Member Services at 800-414-9025. 

Current News, Bulletins and Alerts

Retirement of Moderate Sedation and Physical Medicine and Rehabilitation: Supervised Modalities Policies, and Changes to Procedure to Modifier and IMRT Policies - Effective May and June 2017 - UnitedHealthcare Community Plan of Pennsylvania

Last Modified | 02.22.2019

Effective for claims with dates of service on or after June 1, 2017, UnitedHealthcare Community Plan will implement revisions made to the following reimbursement policies.

Learn More
Alpha Agonist Use in Pediatric Members - Drug Utilization Review Newsletter - UnitedHealthcare Community Plan (Limited Availability)

Last Modified | 02.13.2019

Alpha-Agonist Use in Pediatric Members A Retrospective Drug Utilization Review

Learn More
New All Savers Care Provider Website

Last Modified | 02.04.2019

On Feb. 20, 2019, All Savers Alternate Funding will launch a new care provider website – myallsaversconnect.com. You can use the new website to view and verify member eligibility and coverage details and view and print claim detail and payment summaries

Learn More
Winter 2018 Practice Matters Newsletter - UnitedHealthcare Community Plan of Pennsylvania

Last Modified | 01.10.2019

We hope you enjoy the winter edition of Practice Matters. In this issue, you can read about special needs unit services, support for language services, helping patients quit tobacco, and much more.

Learn More
ABAWD Time Limit Medical Exemption Form - UnitedHealthcare Community Plan of Pennsylvania

Last Modified | 12.13.2018

The Supplemental Nutrition Assistance Program (SNAP, formerly the Food Stamp program), Able-Bodied Adults without Dependents (ABAWD) to only 3 months of SNAP within 36 months.

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.