Provider Resources and Forms

Cultural Competency

Limitations on Provider Marketing

Care provider marketing guidelines
UnitedHealthcare Community Plan of Nebraska will comply with the following care provider marketing guidelines requirements:

UnitedHealthcare Community Plan of Nebraska will obtain and keep on file your written consent when conducting any form of marketing in your office. We will not require you to distribute health plan-prepared marketing communications to your patients. We will not provide you with incentives or giveaways to distribute to (potential) health plan members.

We will not allow you to solicit enrollment or disenrollment in a health plan, or distribute health plan-specific materials at a marketing activity. We will not provide printed materials to you with instructions about how to change health plans to other health plan members. We will instruct you about the following communication requirements:

If you wish to inform your patients of your affiliation with one or more health plans, you must list each health plan with whom you contract.
You may display or distribute health education materials for all contracted health plans, or you may choose not to display or distribute for any contracted health plan.
Health education materials must adhere to the following guidelines:
- Health education posters can be no larger than 16 x 24 inches.
- Children’s books, donated by us, must be in common areas.
- Materials may include our name, logo, telephone number and website address.
- You are not required to distribute and/or display all provided health education materials from each health plan with whom you contract.
- You can choose which items to display as long as you distribute items from each contracted health plan, and that the distribution and quantity of items displayed are impartial.
- You may display Managed Care Organizations (MCOs) marketing materials, provided that appropriate notice is conspicuously and equitably posted, in both size of material and type set, for all health plans with whom you have a contract.
- You may display health plan participation stickers, but if you do you must display stickers for all contracted health plans, or choose not to display stickers for any contracted health plans.
- Health plan stickers indicating that you participate with a particular health plan cannot be larger than 5 x 7 inches and cannot indicate anything more than “the health plan is accepting or welcomed here”.
- You may inform your patients of the benefits, services and specialty care services offered through the health plans in which you participate. However, you may not recommend one health plan over another, offer patients incentives for selecting one health plan over another, or assist the patient in deciding to select a specific health plan in any way, including but not limited to faxing, using the office phone, or a computer in the office.

Upon health plan contract termination, if you contract with other health plans you may notify your patients of the change and the impact of the change on them, including the contract termination date. You must continue to see current patients enrolled with us through the termination date, according to all terms and conditions specified in your Agreement.

We will not produce branded materials instructing members about how to change to a different health plan. You must use MLTC-provided or approved materials and refer members directly to the enrollment broker for needed assistance.

Member Rights and Responsibilities

Members have the right to:

Request information on advance directives.
Be treated with respect, dignity and privacy.
Receive courtesy and prompt treatment.
Receive cultural assistance, including having an interpreter during appointments and procedures.
Receive information about us, rights and responsibilities, their benefit plan and which services are not covered.
Know the qualifications of their health care provider.
Give their consent for treatment unless unable to do so because life or health is in immediate danger.
Discuss all treatment options with you without interference from us.
Refuse treatment through an advance directive or withhold treatment consent.
Be free from any restraint used as discipline, retaliation, convenience or force them to do something they do not want to do.
Receive medically necessary services covered by their benefit plan.
Receive information about in-network care providers and practitioners and choose a care provider from our network.
Change care providers at any time for any reason.
Tell us if they are not satisfied with their treatment or with us; they can expect a prompt response.
Tell us their opinions and concerns about services and care received.
Register grievances or complaints concerning the health plan or the care provided.
Appeal any payment or benefit decision we make.
Review the medical records you keep and request changes and/or additions to any area they feel is needed.
Receive information about their condition, understand treatment options, regardless of cost or whether such services are covered, and talk with you when making decisions about their care.
Get a second opinion with an in-network care provider.
Expect health care professionals are not kept from advising them about health status, medical care or treatment, regardless of benefit coverage.
Make suggestions about our member rights and responsibilities policies.
Get more information upon request, such as on how our health plan works and a care provider’s incentive plan, if they apply.

Patient Centered Medical Home

UnitedHealthcare Community Plan will promote and facilitate the capacity of its network providers to provide patient-centered care by using systematic, patient-centered medical home (PCMH) management processes and health information technology to deliver improved quality of care, health outcomes, and patient compliance and satisfaction. UnitedHealthcare Community Plan will support providers in obtaining accreditation as a Patient-Centered Medical Home (PCMH).

A Patient-Centered Medical Home is a health care delivery model in which a patient establishes an ongoing relationship with a primary care practice team to provide comprehensive, accessible, and continuous evidence-based primary and preventative care, and to coordinate the patient’s health care needs across the health care system to improve quality, safety, access and health outcomes in a cost-effective manner. Members must be active participants in their own health and well-being.

Patient-Centered Medical Home includes the following elements:

Providing comprehensive, coordinated health care for members and consistent, ongoing contact with members throughout their interactions with the health care system, including but not limited to, electronic contacts and ongoing care coordination and health maintenance tracking.
Providing primary health care services for members and appropriate referral to other health care professionals or health professionals with structured follow-up.
Planning and coordinating activities to prevent illness and disease.
Encouraging active participation by a member and their family, guardian, or authorized representative, when appropriate, in health care decision-making and care plan development.
Facilitating the partnership between members, their PCP, and when appropriate, the member’s family.
Encouraging the use of specialty care services and supports.
Providing enhanced access to care outside normal business hours of operation.
Facilitating open scheduling and same-day appointments where possible.

Additionally, UnitedHealthcare Community Plan will support its behavioral health provider network to develop strengthened collaboration with primary care providers (PCPs), service providers, inpatient hospital providers, and consumer/peer providers to better meet all the health needs of members.

Tools to Support Providers
UnitedHealthcare supports practices in PCMH management processes and health information technology solutions through our secure provider portal. Sign In | One Healthcare ID

Online Portal Tools and Technology Assistance for providers includes:

Care Conductor and Notification of Pregnancy: See how to improve outcomes by submitting an Obstetrical Risk Assessment Form (OBRAF) to notify UnitedHealthcare Community Plan of pregnant members.
CommunityCare Provider Portal User Guide: Discover how to access and use the CommunityCare provider portal.
Point of Care Assist: Adds real-time patient information —including clinical, pharmacy, labs, prior authorization, and cost transparency — to your existing electronic medical records (EMRs) to make it easier for you to understand what patients need at the point of care.
Practice Assist: A workflow management tool that enables providers to manage patient care opportunities and suspect medical conditions across multiple health plans.
PreCheck MyScript®: The PreCheck MyScript solution helps make it easy to run a pharmacy trial claim and get real-time prescription coverage detail for your patients who are UnitedHealthcare benefit plan members.
Patient roster management reports: Reports to manage assigned patients.
Patient care opportunities reports (PCOR): Reports to identify gaps in care with assigned patients.

Behavioral Health Integration and Coordination
We encourage providers to use our Behavioral Health Toolkit for Medical Providers designed for PCPs treating patients with behavioral health conditions. This toolkit contains screening tools, referral information, guidelines and a video resource library.

Provider and Staff Toolkits (providerexpress.com)

Value-Based Purchasing
To support first steps from fee-for-service to value, we engage providers in our PCP Incentive (PCPi), a quality model that rewards for closure of care gaps and disparities across wellness, chronic condition, and behavioral health measures.

For practices that are mature in their patient-centered practices may be able to qualify to participate in an Accountable Care Organization VBP model that is structured to provide technical and financial support for greater care coordination, management of population health, behavioral health, and the total cost of care of their members. Practices must maintain open panels and offer extended hours for accessibility and are eligible to share in savings they achieve against total cost of care or clinical efficiency metrics.

Training and Accreditation Resources for becoming a Patient-Centered Medical Home
These organizations provide technical assistance and training as part of the accreditation and recognition for PCMH.

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