Provider Information
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Important InformationProvider Credentialing Department Information
Effective May 1, 2013 UnitedHealthcare Community Plan Credentialing Department Update – go to: http://www.uhccommunityplan.com/physicians-network or call 1.877.842.3210. to learn about important changes in credentialing.
Click here for information regarding HIPAA 5010 and ICD-10.
Effective October 1, 2011, UnitedHealthcare Community Plan will make a change to the notification process for inpatient authorization requests. Click Here (PDF 45.16 KB) for more information.
Precert / Prior Authorization Lists
Precert/Prior Authorization List - Medicaid - CSHCS (PDF 206.3 KB)
Precert/Prior Authorization List - Medicare (PDF 234.21 KB)
Precert/Prior Authorization List - MI Child (PDF 199.77 KB) (PDF 205.44 KB)
Effective 5/1/2013
Precert/Prior Authorization List - Medicaid - CSHCS (PDF 147.31 KB)
Precert/Prior Authorization List - MI Child (PDF 146.68 KB)
Provider Frequently Asked Questions (MEDICAID ONLY)
Medicaid Provider FAQ Guide (PDF 165.44 KB)
Provider Frequently Asked Questions (MIChild only)
MIChild Provider FAQ Guide (PDF 152.09 KB)
Medical Injectables
To review the clinical criteria/guidelines used to conduct medical necessity reviews, please use this link: https://www.unitedhealthcareonline.com/b2c/CmaAction.do?channelId=ca174ccb4726b010VgnVCM100000c520720a____
Provider Links
HEDIS
Mental Health
Obesity Management
PCP Development Surveillance and Screening
Provider Toolkits
Quality Improvement Program
Childhood Immunizations and Well Child Visits
Smoking Cessation
The purpose of the Quality Improvement Program is to achieve desired performance outcomes. UnitedHealthcare Community Plan's Building the Bridge to Excellence QI Program is guided by important objectives. Find out more by clicking here (PDF 18.7 KB) .
Childhood Immunization and Well Child Visits
UnitedHealthcare has identified a performance improvement team to improve Child Immunization and Well Child Visit rates. Click here (PDF 17.96 KB) for detail information.
UnitedHealthcare Community Plan registered nurses has begun the annual HEDIS® (Health Plan Employer Data Information Set) data collection in March 2011. For more details, click here (PDF 15.45 KB) .
Find out more about depression management and primary care by clicking here (PDF 17.35 KB) .
Click here (PDF 19.77 KB) to view Key facts about obesity in the United States.
PCP Developmental Surveillance and Screening
Find out (PDF 22.3 KB) about the implementation of standardized developmental screenings through Assuring Better Child Health and Development (ABCD) Academy.
The Alliance for immunizations in Michigan (AIM) publishes a Provider Toolkit annually with support from Michigan health plans. The Providers Immunization Toolkit for Children & Adults is a resource guide containing the most current standards of practice, forms, & vaccination methodologies for immunization in Michigan. To find out more, click here (PDF 14.62 KB) .
UnitedHealthcare Community Plan's Smoking Cessation Program is supported by both behavioral modification and pharmaceutical assistance to effect maximum support for members who are ready to quit. Click here (PDF 58.34 KB) for details.
Clinical Information- UnitedHealthcare Medical Policies
UnitedHealthcare has developed Medical Policies, Drug Policies, and Coverage Determination Guidelines to assist us in administering health benefits. These policies and guidelines are provided for informational purposes, and do not constitute medical advice.
For Medicare Medical Policies, please click here.
Integrity of Claims, Reports, and Representations to the Government
UnitedHealth Group requires compliance with the requirements of federal and state laws that prohibit the submission of false claims in connection with federal health care programs, including Medicare and Medicaid. Click here (PDF 34.75 KB) to download our policy.
Disclaimer
If UHG Medical Policies conflict with provisions of a State contract or with state or federal law, the contractual / statutory / regulatory provisions shall prevail.
To see updated policy changes, select the Bulletin section at left.