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For UnitedHealthcare Community Plan of Tennessee

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UnitedHealthcare Community Plan of Tennessee 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.

Through an online portal, axialPRACTICE gives you access to resources that help monitor a member’s overall opioid-related risks, including the member’s medication and treatment history from other care providers, information to help you treat common pain complaints, support for managing complex cases, and the opportunity to consult directly with licensed axialHealthcare pharmacists when developing care plans for members. 

Login to the axialPRACTICE Provider Validation Tool using your Optum ID. You will need to fill out a short form with your Tax ID Number (TIN) and National Provider Identifier (NPI) number.

Together, We Can Work to Address Tennessee’s Opioid Crisis

If you’d like to provide evidence-based care for your patients diagnosed with Opioid Use Disorder (OUD), or to identify those at risk, we’re pleased to announce that we’re offering a new Project ECHO training series on Buprenorphine-focused Medication Assisted Treatment (BMAT), starting July 31, 2019.

The series is a collaboration between East Tennessee State University, UnitedHealthcare Community Plan, Amerigroup and BlueCross BlueShield of Tennessee. BMAT Project ECHO aims to equip care providers with the latest clinical information and best practices so you can help improve access for patients suffering from OUD. The six-week online training consists of brief educational sessions, followed by case presentations. Training will be available through July 2020. You can join at any time, even if you missed the first session(s).

BMAT Project ECHO is an interactive experience offering free:

  • Training and support on how to best deliver BMAT services.
  • Weekly didactic sessions with addiction/OUD subject matter experts.
  • Continuing education credits, including Continuing Medical Education (CME).*

After participating in the BMAT Project ECHO series, you should be able to:

  • Identify key components of the MAT model.
  • Explain the benefits of providing MAT.
  • Know how to use the interdisciplinary approach that best fits your practice.

To participate in an upcoming clinical tele-education session, all you need is a computer with a camera and microphone to connect using Zoom, the free, online video conferencing platform. You don’t need a Zoom account to participate.

To learn more and register for an upcoming training, visit etsu.edu/etsubmatecho

*BMAT Project ECHO will offer CME credit to participants in accordance with national CME standards utilized by East Tennessee State University CME office, including prior review of materials for presentation and evaluation, and appropriate disclosure to participants with regard to potential conflicts of interest of presenters.

Provider Call Center

800-690-1606, available Monday-Friday from 8 a.m. – 6 p.m. Eastern Time.

Mailing Addresses 

Postal Mailing Address
UnitedHealthcare Community Plan
8 Cadillac Drive, Suite 100
Brentwood, TN 37027

Claims Address
UnitedHealthcare Community Plan
P.O. Box 5220
Kingston, NY 12402

Utilization Management Appeals Address
UnitedHealthcare Community Plan
P.O. Box 5220
Kingston, NY 12402

Part C Claims 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

Good health outcomes start in the communities where your patients live.  Starting September 20, we invite you to Connect with Us by taking the Providers CARE Survey.

By taking the survey, you’ll give us information about challenges your patients are facing in their communities. Our goal is to help you improve your patients’ health by:

C= Connecting them with community resources (like food pantries and housing help);

A= Acting for better health by teaching them about their care needs;

R=Reducing stigma by showing compassion to others and taking time to think about your actions and thoughts about yourself and others; and

E= Empowering yourself and others. Take the time to listen to your patients. Treating them with kindness and support can help them take the steps they need for better health and supporting them on their journeys to better health

We are here to help you Connect your patients to CARE.  The CARE survey will ask you about the needs of your patients and learning opportunities that can assist your practice team.

To fill out the survey, please visit https://www.tn.gov/tenncare/providers/social-and-health-needs.html

Your answers will not have your name on them and will be combined with information from other providers.

Thank you for caring about the health of your community.

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

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.

View TennCare's policy related to fraud and the Federal and State False Claims Act.

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

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

Plan information is available for:

  • UnitedHealthcare Community Plan - TennCare

Member plan and benefit information can also be found atUHCCommunityPlan.com/TN and myuhc.com.

Member Rights and Responsibilities

The UnitedHealthcare Community Plan Member Rights and Responsibilities can be found in the Provider Manual. Member Rights and Responsibilities are distributed to new members upon enrollment. On an annual basis, members are referred to their handbook to review their Member Rights and Responsibilities.

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

TennCare

UnitedHealthcare Community Plan members can access and manage their TennCare benefit information online with TennCare Connect. You can print and place the TennCare Connect flyer in your office waiting area to help inform your TennCare patients.

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.  

Project ECHO: East Tennessee State University

Buprenorphine Medication Assisted Treatment (BMAT) Project ECHO Trainings Coming Soon

Learn more or register for an upcoming training
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Current News, Bulletins and Alerts

New Edits for UnitedHealthcare Community Plan and UnitedHealthcare Dual Complete® Claims - Effective October 15, 2019

Last Modified | 09.17.2019

We'll be using additional claim edits to help identify claims with incorrect codes before they're processed. This will allow you to quickly submit corrected claims.

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TennCare CHOICES: Implementation of New Reimbursement System for Contracted Nursing Facilities - UnitedHealthcare Community Plan of Tennessee

Last Modified | 09.12.2019

The purpose of this memo is to provide additional information pertaining to implementation of the new quality- and acuity adjusted reimbursement system for Nursing Facilities (NFs).

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TennCare Managed Care Organization Budget Reduction 1% Buyback - UnitedHealthcare Community Plan of Tennessee

Last Modified | 09.05.2019

The 2018 budget approved the buyback of the 1% budget reduction that occurred in state fiscal year 2015. The buyback is effective beginning July 1, 2017.

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2017 4th Quarter Practice Matters Physicians Newsletter - UnitedHealthcare Community Plan of Tennessee

Last Modified | 08.08.2019

We hope you enjoy this edition of Practice Matters. In this issue, you can read about overcoming barriers with eligibility and benefits transactions, the importance of documenting care, preventive health screenings, and much more.

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2019 1st Quarter Practice Matters for UnitedHealthcare Community Plan of Tennessee

Last Modified | 08.08.2019

Practice Matters is a quarterly publication for physicians and other health care professionals and facilities in the UnitedHealthcare network.

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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.

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.