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Provider Information

Welcome to the UnitedHealthcare Community Plan Health Professionals area for Rhode Island providers.

Here, you will find the information and links you need to conduct business with UHC Community Plan. Choose your topic of interest by selecting one of the left navigation buttons.

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 or products below to reveal our Contact Information, Provider Administrative Manuals and Forms.

Contact Us

Provider Call Center	877-842-3210 24 hours a day, 7 days a week and holidays
Postal Mailing Address	UnitedHealthcare Community Plan 475 Kilvert Street Warwick, RI 02886 ATTN: Medicaid Program
Utlization Management Appeals Address	UnitedHealthcare Community Plan P.O. Box 31364 Salt Lake City, Utah 84131

Manuals and Forms

Provider Manual
Rhode Island Provider Manual (PDF 2.82 MB)

Provider Forms
Prior Authorizaton Fax Request Form (PDF 89.89 KB)
Rx Solns Hemo Factor Enrollment Form (PDF 85.68 KB)
Diabetic Form (PDF 26.97 KB)
(PDF 67.61 KB)

CPT (Current Procedural Terminology) Codes
Radiology Crosswalk Table (PDF 197.58 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____

Reimbursement Policies

UnitedHealthcare Community Plan follows CMS and State Medicaid mandates, in the absence of a mandate we follow UnitedHealthcare commercial reimbursement policies. Please refer to the Reimbursement Policy link at the left hand side of this page for a listing of current CMS and/or State Mandated reimbursement policies as well as a link to all additional reimbursement policies.

Provider Notification for VFC Billing (PDF 25.65 KB)

RI Community Plan follows CMS and State Medicaid Mandates; in the absence of a mandate, we follow UHC Commercial reimbursement policies.” Here are the current CMS and State Medicaid Mandates; for all other reimbursement policies, please click here: Rhode Island Reimbursement Policies

See attached payment policies:

CCI Edits (PDF 55.47 KB)

MUE (PDF 1.38 MB)

HCAC (PDF 50.25 KB)

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.