Vision centers that accept unitedhealthcare community plan

Maternal & Child Health (MCH) Information

For important information from the Texas Department of State Health Services on Maternal & Child Health and the formula shortage, visit dshs.state.tx.us/mch.

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

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• September 1, 2022 - MCS COVID-19 Stakeholder Information Session
• Update to Provider Enrollment Revalidation Extensions to End Due to COVID-19 PHE
• Effective June 17, 2022, Reimbursement Rate Updates Implemented for COVID-19 Vaccine Administration Procedure Codes
• COVID-19 Vaccine Administration Procedure Codes 0041A and 0042A Are Now Benefits
• COVID-19 Vaccine Administration Procedure Codes 0081A, 0082A, 0083A, 0111A, 0112A, and 0113A Are Now Benefits for Medicaid and CSHCN
• HHSC is accepting Applications for the Assisted Living Facilities - COVID-19 in Healthcare Relief Request for Application (RFA)
• HHSC Alert: COVID-19 Cases Rise - Guidance for LTC Providers
  
• Healthy Texas Women Claims for Telemedicine (Physician Delivered) and Telephone (Audio-only) Services COVID-19 Guidance Extended to August 31, 2022 
  
• COVID-19 Drug Veklury (Remdesivir) Update
• Update on Ending Continuous Medicaid Coverage Presentation
• Provider Information Sheet - Your Patients’ Medicaid Coverage May Be Impacted by the End of the COVID-19 Public Health Emergency
  
• COVID-19 Update to Temporary Change to HCS, TxHmL Policy for Respite, CFC PAS/HAB Service Providers
• Coronavirus (COVID-19) Home and Community Support Services Agencies (HCSSAs), Including Hospice Inpatient Units - FAQs
• Important Information from UnitedHealthcare on COVID-19
• Texas DSHS Adolescent COVID-19 Vaccine Toolkit
• Texas Public Health COVID-19 Vaccine Scheduler and FAQs
• Texas DSHS Vaccination Provider: Updated Texas COVID-19 vaccine availability
• Texas Health Steps Flexibilities for Telemedicine (Audio-visual) and Telephone (Audio-only) Delivery Training Ending at End of PHE
• Steps to follow in the below order:
  
  • Texas DSHS Vaccination Provider: Step 1 Learn who’s eligible to administer the vaccine
  • Texas DSHS Vaccination Provider: Step 2 Read the Portal Registration Guide
  • Texas DSHS Vaccination Provider: Step 3 CDC vaccine training (not required; Storage and Handling highly recommended)
  • Texas DSHS Vaccination Provider: Step 4 Enroll
• Texas Health and Human Services COVID-19 Vaccine Information for Providers 
• Texas Immunization Registry Webinar Series for Reporting COVID-19
  
• OptumRx: UnitedHealthcare Community Plan of Texas COVID-19 Vaccine Claim Submission
• THMP Extends Expiring Prior Authorization Requests for 90 Days
  
• HHS Announces Enhanced Provider Portal, Relief Fund Payments for Safety Net Hospitals, Medicaid & CHIP Providers
• Texas Medicaid and Healthcare Partnership COVID-19 Information
  
• Reminder: Automatic prior authorization extensions ended Dec. 31, 2020

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

To Providers: Please update your enrollment and demographic information with TMHP (Texas Medicaid Healthcare Partnership). TMHP is HHSC’s provider enrollment administrator and serves as the authoritative source for HHSC Providers’ enrollment and demographic information. Once you update your enrollment and demographic information with TMHP, your data will be reconciled with the demographic information on file with the MCOs.

To make updates to your current enrollment (e.g. new practice locations or change of ownership updates), please access the web page titled “Provider Enrollment” and click on “Enroll Today” at the following URL: Provider Enrollment | TMHP.

For instructions on how to make demographic changes to your current enrollment, please access the web page titled “Provider Enrollment and Management System (PEMS): A Step-by-Step Guide” at the following URL: Provider Enrollment and Management System (PEMS) | TMHP.

Otherwise, you can contact TMHP directly at 800-925-9126 for assistance. 

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

Plan information is available for:

• Care Improvement Plus Dual Advantage (Regional PPO SNP)
  
• Texas STAR
  
• Texas STAR Kids
• Texas STAR+PLUS
  
• UnitedHealthcare Community Plan - Children's Health Insurance Program (CHIP)
  
• UnitedHealthcare Connected (Medicare-Medicaid Plan)
• UnitedHealthcare Dual Complete® (HMO SNP) and UnitedHealthcare Dual Complete® (HMO SNP)
• UnitedHealthcare Dual Complete® (PPO SNP) 

Information available includes:

• Current plan names
  
• Plan details
• Overvew of eligibility information
• Member contact information
• Member Handbook, which includes great information, including:
  • Member rights and responsibilities
  • Member complaints process
  • Member appeals process 

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

The best way for primary care providers (PCPs) to view and export the full member roster is using the CommunityCare tool, which allows you to:  

• Identify Medicaid recipients who need to have their Medicaid recertification completed and approved by the State Agency in order to remain eligible to receive Medicaid benefits
• See a complete list of all members, or just members added in the last 30 days
• Export the roster to Excel
• View most Medicaid and Medicare SNP members’ plans of care and health assessments
• Enter plan notes and view notes history (for some plans)
• Obtain HEDIS information for your member population
• Access information about members admitted to or discharged from an inpatient facility
• Access information about members seen in an Emergency Department

For help using CommunityCare, please see our Quick Reference Guide. If you’re not familiar with our portal, go to UHCprovider.com/portal.

Check out Care Conductor in the UnitedHealthcare Provider Portal under Clinical & Pharmacy.

Complaint

The following complaint form can be sent to:

UnitedHealthcare Community Plan
PO Box 31364
Salt Lake City, UT 84131-0364

• Provider Complaint Form

Claims Reconsiderations and Appeals

A Claims Reconsideration can be completed online faxed.  For more information, see UHCProvider.com > Claims & Payments > Submit a Corrected Claim, Claim Reconsideration/Begin Appeals Process.

An appeal can be sent to:

UnitedHealthcare Community Plan

 Attn:  Complaint and Appeals Dept.

 PO Box 31364

 Salt Lake City, UT 84131-0364

Appeals can be written in a letter format

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

The way you submit a referral request depends on the member’s plan. You can use Eligibility and Benefits to determine the right tool to use for your submission.

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.  

Reporting Fraud, Waste or Abuse to the State of Texas

You can report suspected fraud, waste, or abuse by recipients or providers in Texas health and human services programs online or by calling their toll-free fraud hotline. The Texas health and human services system includes:

• Medicaid
• The Supplemental Nutrition Assistance Program (SNAP, formerly known as Food Stamps)
• Temporary Assistance for Needy Families (TANF)
• Women, Infants, and Children (WIC) program
• The Children's Health Insurance Program (CHIP)

Learn more about how to make a report to Texas Health Human Services.

UnitedHealthcare Dual Complete® Special Needs Plan

UnitedHealthcare Dual Complete Special Needs Plans (SNP) offer benefits for people with both Medicare and Medicaid. These SNP plans provide benefits beyond Original Medicare, and may include transportation to medical appointments and vision exams. Members must have Medicaid to enroll.

Current News, Alerts and Messages from Texas HHSC

Last Modified | 09.28.2022

Starting Jan. 1, 2023, we’ll deny claims submitted without a service facility NPI.

Learn More

Last Modified | 09.12.2022

Attend one of our live town hall events in Texas for long-term services and supports training. See topics and locations.

Learn More

Last Modified | 09.01.2022

Effective Dec. 1, 2022, we’ll require prior authorization for additional CPT® codes for genetic testing.

Learn More

Last Modified | 08.30.2022

UnitedHealthcare provides services to children and pregnant women with health issues and health risks in Texas.

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Last Modified | 08.29.2022

We’ve created a summary of key quality measures to give you a quick resource for providing optimum care for your patients.

Learn More

View More News

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.