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Agsapol iti Pisisyan

Maidawat nga pilyen iti pagilyan nu sadinoka nga agsansanay.
UnitedHealthcare Community Plan
Texas Providers


Here you will find the information, forms, manuals and links you need to conduct business with UnitedHealthcare Community Plan.

Please choose your topic of interest by selecting one of the navigation buttons on the left-hand side of the page, or select one of the topics below.

 

Makiyinnuman Kadakami

Select a plan below for contact information (call center, mailing address and more).

 

Customer Service:  888-887-9003

Provider Relations: 888-303-6162 or providerservicestx@uhc.com

Customer Service for Long Term Services and Supports:  888-787-4107  or uhc_cp_prov_relations@uhc.com

Nursing Facility Providers of Long-Term Care: 866-858-3546 to contact your current assigned provider relations advocate. 

STAR Kids Service Coordination Hotline:  877-352-7798

STAR+PLUS Service Coordination Hotline: 800-349-0550

Report Health Care Fraud, Waste and Abuse: 844-359-7736 or uhc.com/fraud


NurseLine

  • CHIP:  800-850-1267
  • STAR: 800-535-6714
  • STAR+PLUS: 877-839-5407
  • Dual Eligible Members: 877-596-3258

 

 

 

Texas Medicare-Medicaid Plan Logo

Provider Call Center

888-887-9003
Monday-Friday, 8 a.m. – 6 p.m. CST 

Postal Mailing Address

UnitedHealthcare Community Plan
14141 Southwest Freeway
Suite 800
Sugar Land, TX 77478
 

Medical Claims Mailing Address UnitedHealthcare Connected
P.O. Box 31352Salt Lake City, UT 84131-0352
 
Provider Grievances Address           

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

Overbilling and Refund Address

UnitedHealthcare Community Plan
PO Box 740804
Atlanta, GA 30374

Service Delivery Areas

Harris County, Texas

TX Chip logo

Provider Call Center

 

888-887-9003
Monday-Friday  8 a.m. – 6 p.m. CST

 

Postal Mailing Address

 

 

UnitedHealthcare Community Plan
14141 Southwest Freeway
Suite 800
Sugar Land, TX 77478

 

Claims Mailing Address

 

 

UnitedHealthcare Community Plan
PO Box 5270
Kingston, NY 12402-5270

 

Member and Provider
Complaints and Appeals Address

 

 

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

 

Overbilling and Refund Address

 

UnitedHealthcare Community Plan
PO Box 740804
Atlanta, GA 30374

 

Service Delivery Areas Jefferson and Harris

Texas Star Logo

Provider Call Center

 

888-887-9003
Monday-Friday  8 a.m. – 6 p.m. CST

Mailing Address

UnitedHealthcare Community Plan
14141 Southwest Freeway
Suite 800
Sugar Land, TX 77478
 

Claims Mailing Address

UnitedHealthcare Community Plan
PO Box 5270
Kingston, NY 12402-5270
 

Member and Provider Complaints and Appeals     
Address 

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

Overbilling and Refund Address

UnitedHealthcare Community Plan
PO Box 740804
Atlanta, GA 30374

Service Delivery Areas Jefferson, Harris and Hidalgo


TX Star Plus Logo
Provider Call Center

888-887-9003
Monday-Friday, 8 a.m. – 6 p.m. CST

Postal Mailing Address

UnitedHealthcare Community Plan
14141 Southwest Freeway
Suite 800
Sugar Land, TX 77478

Claims Mailing Address

UnitedHealthcare Community Plan
DAGITI CLAIM
PO Box 31352
Salt Lake City, UT 84131-0352

Provider Appeals and Complaints Address           

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

Overbilling and Refund Address

UnitedHealthcare Community Plan
PO Box 740804
Atlanta, GA 30374

Service Delivery Area

Jefferson, Harris, Nueces,
Travis and Central Medicaid
|Rural Service Area (MRSA)
and Northeast MRSA

 

Texas Star Kids Logo

Provider Call Center

888-887-9003
Monday-Friday, 8 a.m. – 6 p.m. CST 

Postal Mailing Address

UnitedHealthcare Community Plan
14141 Southwest Freeway
Suite 800
Sugar Land, TX 77478
 

Medical Claims Mailing Address

UnitedHealthcare Community Plan
PO Box 5290
Kingston, NY 12402-5290
 

Provider Appeals and Complaints Address           

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

Overbilling and Refund Address

UnitedHealthcare Community Plan
PO Box 740804
Atlanta, GA 30374

Service Delivery Areas

Jefferson, Harris, Hidalgo
Medicaid Rural Service Area (MRSA Central) and MRSA Northeast

Messages from Texas Health and Human Services

Small Alternative Device Zip Tie Now Optional (PDF 158.56 KB) - 5.24.2018

To help with Transition to Vesta: Temporary Reducation for EVV Compliance Rate (PDF 12.65 KB) - 5.22.2018

Enrollment Deadline Extended to July 1, 2018 for Medicaid Managed Care Organization Long Term Services and Supports Providers - 5.7.2018

Tour of Texas Info Sessions (PDF 96.57 KB) - 4.25.2018

Transition Timeline EVV (PDF 21.18 KB) - 4.25.2018 

Credentialing Process Update for April 1, 2018 - 4.11.2018 

HHS Information: Galveston County Health District Recommends Testing for Coastal Health and Wellness Patients - 3.27.2018

MEDsys expires Nov. 6, 2018:  What You Need to Know (PDF 172.18 KB) - 3.23.2018

2018 / 2019 Texas Medicaid Zika Standing Order (PDF 110.66 KB) - 3.23.2018 

Help Stop Medicaid Fraud (PDF 132.12 KB) - 10.17.2017 

Zika Mosquito Repellent Benefit Extended to December 2017 (PDF 70 KB) - 9.19.2017

2017 / 2018 Texas Medicaid Zika Standing Order  (PDF 101.09 KB)- 9.19.2017

Notice to Prescribers: Mosquito Repellent Benefit (PDF 64.94 KB) - 9.19.2017

Zika Mosquito Repellent Benefit: Member Education for You (PDF 64.76 KB) - 9.19.2017

Zika CareConnect Fact Sheet (PDF 331.37 KB) - 9.19.2017

Zika CareConnect Frequently Asked Questions (PDF 210.95 KB) - 9.19.2017

Benefit Update for Early Childhood Intervention for Texas Medicaid Effective September 1, 2017 - 9.11.2017

Texas Health and Human Services Message: Use EVV Reason Code 130 if Affected by Hurricane Harvey (PDF 39.81 KB) - 8.28.2017

Physical, Occupational, and Speech Therapy Benefits for All Ages to Change for Texas Medicaid September 1, 2017 - 7.31.2017

Provider Letter: Pre-admission Screening and Resident Reviews and the QSR Process - 7.13.2017

Billing for Zika Tests and Laboraties - 5.31.2017

You need to be Texas Medicaid enrolled to serve CHIP members - 5.31.2017

Pharmacy Notice: Mosquito Repellent Benefit for Zika Prevention (PDF 65.67 KB) - 5.16.2017 

A STAR Kids Letter: LTSS Authorizations Extended No Later than June 30, 2017 (PDF 61.32 KB) - 5.9.2017

Provider Letter Regarding Texas Health Steps Documentation (PDF 36.34 KB) - 1.24.2017

Texas Health Steps Clinical Record Review Tool (PDF 45.1 KB) - 1.24.2017

Texas Health Steps Clinical Record Review Tool with Instructions (PDF 25.97 KB) - 1.24.2017

Texas Health Steps Regional Contacts (PDF 49.06 KB) - 1.24.2017 

Prior Authorization

Outpatient Injectable Chemotherapy Prior Authorization Program Overview (PDF 72.29 KB)

UnitedHealthcare Connected Texas Medicare Medicaid
UnitedHeathcare Connected Texas Medicare Medicaid Plan Prior Authorization Requirements - Effective 4/1/2018 (PDF 270.64 KB)

UnitedHealthcare Medicare Solutions & UnitedHealthcare Community Plan
UnitedHealthcare Medicare Prior Authorization Requirements - Effective 4/1/2018 (PDF 293.21 KB)

UnitedHealthcare Community Plan - CHIP
UnitedHealthcare Community Plan Prior Authorization TX CHIP - Effective 4/1/2018 (PDF 222.9 KB)

UnitedHealthcare Community Plan - STAR
UnitedHealthcare Community Plan Prior Authorization TX STAR - Effective 4/1/2018 (PDF 225.55 KB)

UnitedHealthcare Community Plan - STAR Kids
UnitedHealthcare Community Plan Prior Authorization TX STAR Kids - Effective 4/1/2018 (PDF 234.46 KB)

UnitedHealthcare Community Plan - STAR+PLUS
UnitedHealthcare Community Plan Prior Authorization TX STAR+PLUS - Effective 4/1/2018 (PDF 233.83 KB)

UnitedHeathcare Connected Texas Medicare Medicaid Plan Prior Authorization Requirements - Effective 1/1/2018  (PDF 250.43 KB)

UnitedHealthcare Community Plan Prior Authorization TX CHIP - Effective 1/1/2018 (PDF 223.3 KB)

UnitedHealthcare Community Plan Prior Authorization TX STAR - Effective 1/1/2018 (PDF 225.89 KB)

UnitedHealthcare Community Plan Prior Authorization TX STAR Kids - Effective 1/1/2018 (PDF 232.25 KB)

UnitedHealthcare Community Plan Prior Authorization TX STAR+PLUS - Effective 1/1/2018 (PDF 230.78 KB)

UnitedHealthcare Medicare Prior Authorization Requirements - Effective 1/1/2018  (PDF 282.37 KB)

UnitedHeathcare Connected (Medicare-Medicaid Plan) Prior Authorization Requirements - Effective 7/1/2017 (PDF 242.65 KB) 

UnitedHealthcare Medicare Prior Authorization Requirements - Effective 1/1/2018 (PDF 282.37 KB)

UnitedHealthcare Community Plan Prior Authorization TX CHIP - Effective 7/1/2017 (PDF 226.53 KB)

UnitedHealthcare Community Plan Prior Authorization TX STAR - Effective 7/1/2017 (PDF 225.15 KB)

UnitedHealthcare Community Plan Prior Authorization TX STAR Kids - Effective 7/1/2017 (PDF 232.22 KB)

UnitedHealthcare Community Plan Prior Authorization TX STAR+PLUS - Effective 7/1/2017 (PDF 225.95 KB)

UnitedHealthcare Medicare Prior Authorization Requirements - Effective 10/1/2017 (PDF 286.74 KB)

UnitedHealthcare Medicare Solutions and UnitedHealthcare Community Plan-Medicare Notification/Prior Authorization Requirements - Effective 7/1/2017 (PDF 300.09 KB)

UnitedHealthcare Community Plan Prior Authorization TX CHIP - Effective 4/1/2017 (PDF 219.45 KB)

UnitedHealthcare Community Plan Prior Authorization TX STAR - Effective 4/1/2017 (PDF 239.82 KB)

UnitedHealthcare Community Plan Prior Authorization TX STAR Kids - Effective 4/1/2017 (PDF 229.98 KB)

UnitedHealthcare Community Plan Prior Authorization TX STAR+PLUS - Effective 4/1/2017 (PDF 203.78 KB)

UnitedHealthcare Medicare Solutions and UnitedHealthcare Community Plan-Medicare Notification/Prior Authorization Requirements  - Effective 5/1/2017 (PDF 299.55 KB)

UnitedHealthcare Medicare Solutions and UnitedHealthcare Community Plan-Medicare Notification/Prior Authorization Requirements -  Effective 1/1/2017 (PDF 306.96 KB)

UnitedHealthcare Medicare Solutions and UnitedHealthcare Community Plan-Medicare Notification/Prior Authorization Requirements - Effective 4/1/2017 (PDF 300.79 KB)

Prior Authorization TX CHIP - Effective 1/1/2017 (PDF 218.73 KB)

Prior Authorization TX STAR - Effective 1/1/2017 (PDF 218.24 KB)

Prior Authorization TX STAR Kids - Effective 1/1/2017 (PDF 227.58 KB)

Prior Authorization TX STAR+PLUS - Effective 1/1/2017 (PDF 203.46 KB)

UnitedHealthcare Community Plan Prior Authorization TX STAR -Effective 10/1/2016 (PDF 218.7 KB)

UnitedHealthcare Community Plan Prior Authorization TX STAR PLUS - Effective 10/1/2016 (PDF 203.13 KB)

UnitedHealthcare Community Plan Prior Authorization TX CHIP - Effective 10/1/2016 (PDF 216.01 KB)

UnitedHealthcare Community Plan Prior Authorization TX STAR Kids - Effective 10/1/2016 (PDF 226.16 KB)

UnitedHealthcare Medicare Solutions and UnitedHealthcare Community Plan Notification / Prior Authorization Requirements -Effective 10/1/2016 (PDF 277.31 KB)

UnitedHealthcare Community Plan Prior Authorization TX STAR - Effective 7/1/2016 (PDF 196.79 KB)

UnitedHealthcare Community Plan Prior Authorization TX STAR PLUS - Effective 7/1/2016 (PDF 195.63 KB)

UnitedHealthcare Community Plan Prior Authorization TX CHIP - Effective 7/1/2016 (PDF 195.03 KB)

UnitedHealthcare Medicare Solutions and UnitedHealthcare Community Plan Notification/Prior Authorization Requirements - Effective 7/1/2016 (PDF 266.74 KB)

UnitedHealthcare Medicare Solutions and UnitedHealthcare Community Plan Notification/Prior Authorization Requirements - Effective 5/1/2016 (PDF 251.42 KB)

UnitedHealthcare Community Plan Prior Authorization TX STAR.STAR+PLUS - Effective 5/1/2016 (PDF 201.6 KB)

UnitedHealthcare Community Plan Prior Authorization TX CHIP - Effective 5/1/2016 (PDF 193.82 KB)

 

Medical Injectables

Dagiti medikasyon ti Espesyalidad nga parmasya ket masakop ti Medikal a Benepisyo mabalin nga maited ti agababali nga channels - home infusion nga pasilidad, outpatient nga pasilidad, wenno espesyalidad nga parmasya.

Specialty pharmacy medications covered under the member’s medical benefit may be obtained through various sources ‒ home infusion providers, outpatient facilities, physicians or specialty pharmacy.

If you don’t want to buy and bill a specialty pharmacy medication covered under the member’s medical benefit, you may order it through the following network specialty pharmacy:

Ispesyalista a Parmasiya ti Network

Numero iti Telepono

BriovaRx

855-427-4682

The following specialty pharmacies also provide certain types of specialty medications:

Ispesyalista a Parmasiya ti Network

Kategorya ti Panagagas

Numero iti Telepono

Accredo (nursing services)

Enzyme Deficiency

Gaucher's Disease

Immune Globulin

Pulmonary Hypertension

800-803-2523

 

Option Care (nursing services)

Enzyme Deficiency

Gaucher's Disease

Hemophilia

Immune Globulin

Makena

866-827-8203

Ispesyalista a Parmasiya ti CVS Caremark

Pulmonary Hypertension

800-237-2767


Coverage of a requested medication depends on the member’s benefit, and availability of a specific drug from a network specialty pharmacy may vary.

Upon request, a specialty pharmacy can deliver the medication to your office or another site such as a member’s home.

Medications obtained through a specialty pharmacy will be directly billed to the patient’s health plan.

 

UnitedHealthcare Community Plan Medical & Drug Policies and Coverage Determination Guidelines

UnitedHealthcare has developed Medical Policies, Medical Benefit Drug Policies and Coverage Determination Guidelines to assist us in administering health benefits. Dagitoy a pagalagadan ken pagannurotan ket maipaay para ti panangipakaammo a ranta, ken saan a mangbukel ti medikal a balakad.
View the guidelines

UnitedHealthcare Medicare Advantage Coverage Summaries

For policy guidance for Medicare Advantage plan members, view the UnitedHealthcare Medicare Advantage Coverage Summaries Manual and corresponding policy update bulletins here

Medical Policy Update Bulletin

UnitedHealthcare Community Plan Medical Policy Update Bulletin

Integridad ti Claims, Reports, ken Panangibagi iti Gobyerno

UnitedHealth Grupo ket dawatenna ti panagtungpal kadagiti dawdawaten ti pederal ken paglintegan ti estado nga mangiparit ti panagsumite ti palso a claims a maikamang iti pederal a programa ti pannakasalwad ti salun-at, pakairamanan ti Medicare ken Medicaid.
View our policy (PDF 38.15 KB).

Panangilibak

If UHG policies conflict with provisions of a state contract or with state or federal law, the contractual / statutory / regulatory provisions shall prevail. Tapno makita ti pakaaamo a panagbalbaliw ti pagalagadan, pilien ti Pagwarnakan a seksiyon iti kanigid.