UnitedHealthcare Community Plan of Ohio

Provider call center

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

Postal mailing address

UnitedHealthcare Community Plan
9200 Worthington Road, 3rd Floor
Westerville, OH 43082

Claims mailing address

UnitedHealthcare Community Plan
P.O. Box 8207
Kingston, NY 12402

Utilization management appeals address  

UnitedHealthcare Community Plan
Attn: Complaint and Appeals Department
P.O. Box 31364
Salt Lake City, UT 84131
Fax: (801) 994-1082

Claims appeals mailing address

UnitedHealthcare Community Plan
Attn: Complaint and Appeals Department
P.O. Box 31364
Salt Lake City, UT 84131
Fax: (801) 994-1082

UHC Connected for MyCare Ohio appeals mailing address

Part C Appeals or Grievances:
UnitedHealthcare Community Plan
Attn: Complaint and Appeals Department
P.O. Box 31364
Salt Lake City, UT 84131
Fax: (801) 994-1082

Medicare Part D Grievances:
UnitedHealthcare Community Plan
Attn: Complaint and Appeals Department
P.O. Box 31364
Salt Lake City, UT 84131
Fax: (801) 994-1082

Medicare Part D Appeals:
UnitedHealthcare Community Plan
Attn: Part D Standard Appeals
P.O. Box 6103
Cypress, CA 90630-9998
Fax: (877) 960-8235

For Credentialing and attestation updates, visit the Ohio Department of Medicaid website.

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

Visit the provider updates and data attestation page.

External medical review (EMR) is a review process conducted by an independent, external medical review entity. It is initiated by a provider who disagrees with the decision of a managed care organization (MCO) and/or the OhioRISE (Resilience through Integrated Systems and Excellence) plan to deny, limit, reduce, suspend or terminate a covered service for lack of medical necessity.

If you would like more information on EMRs, the Ohio Department of Medicaid (ODM) provides some helpful provider resources, including Frequently Asked Questions (FAQs), a Prior Authorization Denial Grid and the EMR process flow. All can be found on the ODM website.

Stay informed on the latest winter respiratory illness trends by subscribing to the Optum® Infectious Disease Platform (IDP) reporting email. With this near-real time data, you can make critical patient care decisions quicker.

COVID-19

• Our COVID-19 Information and Resources page
• Ohio Department of Health COVID-19 Reporting visualizer
• Ohio Department of Medicaid COVID-19 Information resources page
  
  

Influenza

The CDC recommends that everyone 6 months and older receive a flu vaccine each season, with few exceptions. Children 6 months through 8 years old may need 2 doses for best protection.

RSV

• The CDC’s Update on RSV and New Vaccine Recommendation page

Thank you for your interest in joining the UnitedHealthcare Community Plan of Ohio network. In joining our network, you’ll become part of a group of health care professionals and facilities who share our commitment to helping Ohio members live healthier lives and making the health care system better for everyone.

There are 3 key phases to joining the network:

1. Start application; you can save your progress and resume at any time
2. UnitedHealthcare reviews collected information from application and helps fix any issues
3. Sign documents through Adobe Sign to complete enrollment

Need help? If you have questions about the process, connect with us through chat in the UnitedHealthcare Provider Portal or call UnitedHealthcare Community Plan of Ohio Provider Services at 800-600-9007.

To begin the contracting process:

1. Fill out the W-9 Form and application within Onboard Pro
2. After our team receives the completed W-9 Form and Onboard Pro application, we’ll begin the validation process against the Provider Network Module (PNM). If the information matches, we’ll send you a nondisclosure agreement (NDA) through Adobe Sign. This process can take 5–10 days.
3. During the above time frame, we’ll draft the contract and payment appendix to send for internal reviews/approvals. Depending on the contract effective date, load times can range between 30–60+ days.
4. Once contract documents are reviewed/approved, the network contractor will send the contract for execution
5. After receipt of the fully executed agreement, we’ll confirm the contract effective date and send you a welcome letter. This includes the fully executed agreement sent to you through Adobe Sign as well as next steps and onboarding resources for newly contracted providers.

Onboarding process
For more information, please view our Home and Community-Based Service (HCBS) and Long-Term Services and Support (LTSS) interactive guide.

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.

Visit UHCCommunityPlan.com/OH 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 of Ohio
• UnitedHealthcare Connected® for MyCare Ohio
  
• UnitedHealthcare Dual Complete (HMO SNP)
• UnitedHealthcare Dual Complete (HMO-POS SNP)

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

Search for a care provider 

• UnitedHealthcare Community Plan of Ohio
• UnitedHealthcare Connected® for MyCare Ohio
• UnitedHealthcare Dual Complete® (HMO SNP)
• UnitedHealthcare Dual Complete® (HMO-POS SNP)

Search for a dentist

• UnitedHealthcare Connected® for MyCare Ohio
• UnitedHealthcare Dual Complete® (HMO SNP) and UnitedHealthcare Dual Complete® (HMO-POS SNP)

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

Visit the provider updates and data attestation page.

The Ohio provider contract with United HealthCare Community Plan is listed below.

• The Ohio Medicaid Fee Schedule
• CMS Fee Schedule (Medicare)

Effective Oct. 20, 2023, Next Generation Medicaid managed care organizations (MCOs), the OhioRISE plan and MyCare Ohio plans must use provider data from Ohio Medicaid’s Provider Network Management (PNM) module as the official system of record. Health care professionals must keep their records updated within the PNM module. If your data in the PNM module does not match the data on your submitted claims, your claims will be denied for payment.

Get the details

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.