General resources for Community Plans

As a reminder, UnitedHealthcare Community Plan has appointment availability requirements for PCPs and specialists. The requirements apply to routine, urgent and after-hours care. For specific information, please refer to your provider administrative manual, which can be found at UHCprovider.com/en/admin-guides/cp-admin-manuals.html. 

The UnitedHealthcare Community Plan Case Management program is a holistic approach to care for members with complex needs, especially for those with chronic conditions. The goal is to keep our members in the community with the resources necessary to maintain the highest functional status possible.

What can the UnitedHealthcare Community Plan case manager provide for your patients?

• Telephonic contact with members and facilitation of home visits
• Health education and educational materials
• A health assessment with stratification of diagnosis and severity of condition and
  psychosocial needs
• Referral to community resources as needed
• Assistance with medical transportation
• Arrangements for durable medical equipment (DME) and ancillary services as needed or ordered by the physician
• Outreach to members to promote assistance with keeping doctor's appointments
• Work with members to identify and address barriers to seeking health care and following their medical treatment plan of care

How to refer
For more information or to make a referral, call our referral line at 877-542-9235.

UnitedHealthcare Community Plan has identified evidence-based clinical practice guidelines that are available as resources. The guidelines cover a variety of conditions, such as diabetes, asthma, depression, as well as preventive care. They can be found at UHCprovider.com/cpg or you may call 877-542-9235 for a copy.

UnitedHealthcare wants to underscore the importance of ongoing communication between primary care providers (PCP) and specialists. PCPs and specialists share responsibility for communicating essential patient information regarding consultations, treatment plans and referrals. Relevant information from the PCP should include the patient's history, diagnostic tests and results and the reason for the consultation. The specialist is responsible for timely communication of the results of the consultation and ongoing recommendations and treatment plans.

The information exchange between practitioners should be timely, relevant and accurate to facilitate ongoing patient management. The partnership between the PCP and specialist is based on the consistent exchange of clinical information and is a critical factor in providing quality patient care.
The provider administrative guide addresses coordination of care and expectations of our providers. For more information, please refer to the provider administrative guide for the applicable state at UHCprovider.com/en/admin-guides/cp-admin-manuals.html.

Just a reminder, the UnitedHealthcare Community Plan member rights and responsibilities can be found in the care 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.

UnitedHealthcare Community Plan pharmacy updates are available at UHCprovider.com > Menu >  Health Plans by State > select state > Medicaid (Community Plan) > Pharmacy Resources and Physician-Administered Drugs.

You can find this information online:

• A list of covered pharmaceuticals, including restrictions and preferences
• Pharmaceutical management procedures
• Explanations on limits or quotas
• How to submit and support special requests
• Generic substitution, therapeutic interchange and step-therapy protocols
  

Call the pharmacy hotline at 800-922-1557.

UnitedHealthcare Community Plan serves a diverse group of individuals.  Each state within UnitedHealthcare Community Plan has unique membership that has its own cultural and language needs.  Information about our membership is collected and analyzed in order to provide our members with healthcare services that meet their individual cultural and language needs.  An example of some of our diverse membership by state can be found in the table below:

UnitedHealthcare supports our practitioners in their efforts to provide culturally appropriate care by providing cultural competency training and language services to effectively communicate with our members.  Language assistance is available to help providers communicate with members.  Services include a telephone language line, in-person interpreters, and video services.  We also have tools to promote cultural awareness and assist practitioners in recognizing and treating health disparities. 

Visit UHCprovider.com/en/resource-library/patient-health-safety/cultural-competency.html to find our more information and to access the following tools:

• Quick reference guide – Understanding Cultural Competency and the Americans with Disabilities Act
• The Cross-Cultural Health Care program
• Cultural Orientation Resource Center

You may also call 877-542-9235 to get more information on how to obtain language assistance and interpreter services for our members.

UnitedHealthcare Community Plan staff performs concurrent reviews on inpatient stays in acute, rehabilitation and skilled nursing facilities, as well as prior authorization reviews of selected services. The Prior Authorization and Notification tool provides a listing of services that require prior authorization. You can learn more about the tool at UHCprovider.com/paan. Training is available in the Videos and Training section of the website. A physician reviews all cases in which the care does not appear to meet guidelines. Decisions regarding coverage are based on the appropriateness of care and service and existence of coverage. We do not provide financial or other rewards to our physicians for issuing denials of coverage or for underutilizing services.

If you have questions or would like specific utilization management criteria, you can talk to our staff. Call toll-free at 877-542-9235. Staff is available 8 hours per day from 9 a.m.–5 p.m. ET.