UnitedHealthcare Community Plan of Texas

Credentialing and Recredentialing FAQs for Health Care Professionals

For questions about credentialing and attestation updates, connect with us through chat 24/7 in the UnitedHealthcare Provider Portal.. For additional contact information, visit our Contact us page.

How to: Credentialing and recredentialing

Texas Facilities enrolled in Texas Medicaid can submit the Texas Facility Credentialing Application directly to Verisys, the Texas Association of Health Plans’ (TAHP’s) contracted Credentialing Verification Organization (CVO). The application can be submitted via one of the following methods: 

• Upload to the secure document submission website using Access Code: aperture
• Email to to TAHPapps@verisys.com using  the bar-coded letter at the top page of the PDF document
• Fax to 866-293-0421 using the bar-coded letter as a cover sheet
• Mail to:
  Verisys
  P.O. Box 221049
  Louisville, KY 40252-104

If you have trouble accessing or submitting the application, contact UnitedHealthcare Provider Services, toll-free, at 888-887-9003, 8 a.m. to 6 p.m. CT, Monday-Friday or the Verisys customer service team at 1-855-743-6161. Verisys may also contact you directly to initiate the facility credentialing process.

• 10.19.2023 - The End of Continuous Medicaid Coverage and How You Can Help
• 08.07.2023 - End of Continuous Medicaid Coverage Ambassador Toolkit
• 04.25.2023 - Important notice: Help Your Patients Avoid a Lapse in their Medicaid Coverage
  
• 03.14.2023 - Important Information About Checking Client Eligibility
  
• 02.02.2023 - HHSC Urges All Medicaid Recipients to Update Their Contact Information As Continuous Medicaid Coverage Requirement Ends
• 02.02.2023 - HHSC Provider Information Sheet
• 02.02.2023 - HHSC Medicaid Coverage Flyer

UnitedHealthcare Community Plan provides:

• Cultural competency resources
• Training - Cultural Competency and the American with Disabilities Act
• Data attestation page to keep your provider profile current.
• Language interpretation line with oral interpreter services 24 hours a day, 7 days a week in more than 240 non-English languages and hearing-impaired services are available. Members can call the phone number on their ID card.
• Professional interpreters are available: 
  • During regular business hours, call Provider Services at 1-888-887-9003.
  • After hours, call Language Line Solutions at 1-877-261-6608. Enter the client ID 209677 (do not hit #). Press 1 for Spanish and 2 for all other languages.
    
• I Speak language assistance card for providers helps identify preferred language and provides directions to arrange interpretation services for UnitedHealthcare members.
• Materials for visually impaired, limited English-speaking members and those who speak languages other than English or Spanish. For more information, go to uhc.com > Language Assistance.
  

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 on the Portal - A Step-by-Step Guide” 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. 

• Behavioral Health for Mental Health and Substance Use Issues
  
• Cultural Competency Library
• Optum Rx
  
• Patient-Centered Medical Home (PCMH)
• Texas Department of Family and Protective Services
• Texas Department of Family and Protective Services Policies
• Texas Department of State Health Services - Texas Health Steps Provider Page
• Texas Health and Human Services Commission
• Texas Health and Human Services Commission Contracts and Manuals
• Texas Health Steps Regional Representatives Contact List
• Texas HHSC Nursing Facility Unit Rates
• Texas Medicaid and Healthcare Partnership (TMHP)
• Texas Office of Consumer Credit Commissioner Guide to Financial Literacy and Education Resources
• Think Cultural Health
• UnitedHealthcare Dental

Behavioral health providers

Learn how to join the behavioral health network, review behavioral health information, or submit demographic changes at  Community Plan Behavioral Health.

Medical providers including facility/hospital-based, group/practice and individually-contracted clinicians

The state-specific requirements and process on how to join the UnitedHealthcare Community Plan network are 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..

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.

If our members need help with finding a provider, specialty consultation, or referral, or they have a question about their health plan, please have them call us. 

Our Member Services in Texas can be reached toll-free at 1-888-887-9003, TDD/TTY: 7-1-1, 8:00 a.m.-8:00 p.m., Monday-Friday.

Member rights

1.  You have the right to respect, dignity, privacy, confidentiality, and nondiscrimination. That includes the right to:

a.  Be treated fairly and with respect.

b.  Know that your medical records and discussions with your providers will be kept private and confidential.

2.  You have the right to a reasonable opportunity to choose a health care plan and Primary Care Provider. This is the doctor or health care Provider you will see most of the time and who will coordinate your care. You have the right to change to another plan or Provider in a reasonably easy manner. That includes the right to:

a.  Be told how to choose and change your health plan and your Primary Care Provider.

b.  Choose any health plan you want that is available in your area and choose your Primary Care Provider from that plan.

c.   Change your Primary Care Provider.

d.  Change your health plan without penalty.

e.   Be told how to change your health plan or your Primary Care Provider.

3.  You have the right to ask questions and get answers about anything you do not understand. That includes the right to:

a.   Have your provider explain your health care needs to you and talk to you about the different ways your health care problems can be treated.

b.  Be told why care or services were denied and not given.

c.  Be given information about your health, plan, services, and providers.

d.  Be told about your rights and responsibilities.

4.  You have the right to agree to or refuse treatment and actively participate in treatment decisions. That includes the right to:

a.  Work as part of a team with your provider in deciding what health care is best for you.

b. Say yes or no to the care recommended by your Provider.

5.  You have the right to use each Complaint and appeal process available through the Managed Care Organization and through Medicaid, and get a timely response to complaints, appeals, External Medical Reviews and State Fair Hearings. That includes the right to:

a.  Make a Complaint to your health plan or to the state Medicaid program about your health care, your Provider, or your health plan.

b.  Get a timely answer to your complaint.

c.   Use the plan’s appeal process and be told how to use it.

d.  Ask for an External Medical Review and State Fair Hearing from the state Medicaid program and get information about how that process works.

e.   Ask for a State Fair Hearing without an External Medical Review from the state Medicaid program and receive information about how that process works.

6.  You have the right to timely access to care that does not have any communication or physical access barriers. That includes the right to:

a.  Have telephone access to a medical professional 24 hours a day, 7 days a week to get any emergency or urgent care you need.

b. Get medical care in a timely manner.

c.  Be able to get in and out of a health care Provider’s office. This includes barrier free access for people with disabilities or other conditions that limit mobility, in accordance with the Americans with Disabilities Act.

d.  Have interpreters, if needed, during appointments with your providers and when talking to your health plan. Interpreters include people who can speak in your native language, help someone with a disability, or help you understand the information.

e.  Be given information you can understand about your health plan rules, including the Health Care Services you can get and how to get them.

7.  You have the right to not be restrained or secluded when it is for someone else’s convenience, or is meant to force you to do something you do not want to do, or is to punish you.

8.  You have a right to know that doctors, hospitals, and others who care for you can advise you about your health status, medical care, and treatment. Your health plan cannot prevent them from giving you this information, even if the care or treatment is not a Covered Service.

9.  You have a right to know that you are not responsible for paying for Covered Services. Doctors, hospitals, and others cannot require you to pay copayments or any other amounts for Covered Services.

10.  You have a right to make recommendations to your health plan’s member rights and responsibilities.

Member responsibilities

1. You must learn and understand each right you have under the Medicaid program. That includes the responsibility to:

a.  Learn and understand your rights under the Medicaid program.

b.  Ask questions if you do not understand your rights.

c.   Learn what choices of health plans are available in your area.

2.  You must abide by the health plan’s and Medicaid’s policies and procedures. That includes the responsibility to:

a.  Learn and follow your health plan’s rules and Medicaid rules.

b.  Choose your health plan and a Primary Care Provider quickly.

c.  Make any changes in your health plan and Primary Care Provider in the ways established by Medicaid and by the health plan.

d.  Keep your scheduled appointments.

e.  Cancel appointments in advance when you cannot keep them.

f.   Always contact your Primary Care Provider first for your non-emergency medical needs.

g.  Be sure you have approval from your Primary Care Provider before going to a specialist.

h.  Understand when you should and should not go to the emergency room.

3. You must share information about your health with your Primary Care Provider and learn about service and treatment options. That includes the responsibility to:

a.  Tell your Primary Care Provider about your health.

b. Talk to your providers about your health care needs and ask questions about the different ways your health care problems can be treated.

c.  Help your providers get your medical records.

4. You must be involved in decisions relating to service and treatment options, make personal choices, and take action to keep yourself healthy. That includes the responsibility to:

a.  Work as a team with your provider in deciding what health care is best for you.

b.  Understand how the things you do can affect your health.

c.   Do the best you can to stay healthy.

d.  Treat providers and staff with respect.

e.  Talk to your provider about all of your medications.

Additional member responsibilities while using non-emergent medical transportation (NEMT) services

1.  When requesting NEMT Services, you must provide the information requested by the person arranging or verifying your transportation.

2.  You must follow all rules and regulations affecting your NEMT services.

3.  You must return unused advanced funds. You must provide proof that you kept your medical appointment prior to receiving future advanced funds.

4.  You must not verbally, sexually, or physically abuse or harass anyone while requesting or receiving NEMT services.

5.  You must not lose bus tickets or tokens and must return any bus tickets or tokens that you do not use. You must use the bus tickets or tokens only to go to your medical appointment.

6.  You must only use NEMT Services to travel to and from your medical appointments.

7.  If you have arranged for an NEMT Service but something changes, and you no longer need the service, you must contact the person who helped you arrange your transportation as soon as possible.

If you think you have been treated unfairly or discriminated against, call the U.S. Department of Health and Human Services (HHS) toll-free at 1-800-368-1019. You also can view information concerning the HHS Office of Civil Rights online at www.hhs.gov/ocr.

Nurse hotlines - available 24 hours a day, 7 days a week.

• CHIP - 1-844-644-7429 
• MMP - 1-844-901-3680
• STAR - 1-866-505-0489
• STAR Kids - 1-844-901-3680
• STAR+PLUS - 1-833-756-8592

The primary function of the Network Provider Advisory Group (NPAG) is to discuss and advise on the dynamics of managed care in the specified Service Delivery Area, which is represented. The committee will also provide a stabilizing influence so organizational concepts and directions are established and maintained. Members of the Advisory Group will help identify issues, so that UnitedHealthcare Community Plan of Texas can adequately address them. In practice, these responsibilities will be carried out by performing the following functions: 

• Participate in face-to-face, WebEx meetings and conference calls
• Monitor and review pertinent documents at regular Advisory Group meetings
• Advise when emergent issues force changes to be considered and ensure that scope aligns with the agreed requirements 
• Resolve conflicts and disputes, reconciling differences of opinion and approach
• Advise on prioritization of objectives and outcomes as identified 

The NPAG will meet quarterly in a teleconference/WebEx format. The schedule is dictated by state fiscal year.

If a provider is interested in joining, please send an email to uhc_cp_prov_relations@uhc.com.

What are NEMT services?

NEMT services provide transportation to covered health care services for patients who have no other means of transportation. Such transportation includes rides to the doctor, dentist, hospital, pharmacy and other places an individual receives Medicaid services. NEMT services do NOT include ambulance trips or transportation while receiving LTSS.

Contact information

If you have a member you think would benefit from receiving NEMT services, please refer them to us for information. They can call customer service at 1-888-887-9003. For inquiry follow-ups that surpass 3 days or escalation requests, send an email to Tx.Transportation@modivcare.com.

Member responsibilities

When using non-emergent medical transportation (NEMT) services, you have the responsibilities to:

• Provide the information requested by the person arranging or verifying your transportation.
• Follow all rules and regulations affecting your NEMT services. 
• Return unused advanced funds. You must provide proof that you kept your medical appointment prior to receiving future advanced funds.
• Do not verbally, sexually or physically abuse or harass anyone while requesting or receiving NEMT services. 
• You must not lose bus tickets or tokens and must return any bus tickets or tokens that you do not use. You must use the bus tickets or tokens only to go to your medical appointment. 
• Only use NEMT Services to travel to and from your medical appointments.
• Contact the person who helped you arrange your transportation as soon as possible if something changes and you no longer need the service.

Note: For inquiry follow-ups that surpass 3 days or escalation requests, send an email to Tx.Transportation@modivcare.com.

UnitedHealthcare Community Plan contracts with nursing facilities for network participation.

Nursing Facility Providers of Long-Term Care who need to reach a provider relations advocate can:

• Call: 866-858-3546 
• Email: nhpr3@optum.com

For additional assistance, contact:
Sandi Howard, NSLS, BSHA, MHA
Director of Medicaid Provider Engagement
Office 1-952-202-3559
Fax 1-855-529-4794
sandi.howard@optum.com

Complaints

File verbally by phone:

• Call Customer Service at 1-888-887-9003

File by fax:

The following complaint form can be sent by fax:

• Provider Complaint Form
• Fax: 801-994-1082

File by mail:

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

The HHSC mailbox for provider complaints: HPM_Complaints@hhsc.state.tx.us.

Claims Reconsiderations and Appeals

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

An appeal or reconsideration can be sent to by mail to:

• UnitedHealthcare Community Plan
  Attn:  Complaint and Appeals Dept.
  PO Box 31364
  Salt Lake City, UT 84131-0364

File by fax: 

• Fax a letter to 1-801- 994-1082 

File online:

• Submit an Appeal for a Medicaid Member log in with your One Healthcare ID to https://www.uhcprovider.com/en/restricted/sec_aandg.html.

Inquire by phone: 

• Call Customer Service at 888-887-9003 

Questions? 

• Send email to uhc_cp_prov_relations@uhc.com

Search for a care provider by plan name: 

• Children's Health Insurance Program (CHIP)
• STAR
• STAR Kids
• STAR+PLUS
• UnitedHealthcare Connected® (Medicare-Medicaid Plan)
• UnitedHealthcare Dual Complete® (HMO SNP) and UnitedHealthcare Dual Complete® (HMO SNP)
• UnitedHealthcare Dual Complete® (PPO SNP)

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

Visit the provider updates and data attestation page

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.

Visit the eligibility and referrals page

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.