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Provider Information

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

Provider Alerts: Attestation form (PDF 36.37 KB) | PCP Fee Schedule Increase FAQ
(PDF 22.44 KB) | PCP Rate Increase Announcement Letter (PDF 29.05 KB)

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	800-690-1606 8 a.m. – 6 p.m., EST
Postal Mailing Address	UnitedHealthcare Community Plan 8 Cadillac Drive, Suite 100 Brentwood, TN 37027
Claims Address	UnitedHealthcare Community Plan P.O. Box 5220 Kingston, NY 12402
Utlization Management Appeals Address	UnitedHealthcare Community Plan P.O. Box 5220 Kingston, NY 12402
Claims Appeals Address	UnitedHealthcare Community Plan P.O. Box 5220 Kingston, NY 12402

Clinical

CHOICES (Long Term Care)

United Healthcare Community Plan (TennCare)

United Healthcare Dual Complete Preferred (HMO/SNP)

Tools and Resources

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____

CHOICES (Long Term Care)

Coverage Policy Library

UnitedHealthcare Community Plan (TennCare)

Coverage Policy Library
UnitedHealthcare Community Plan Provider Quick Reference Guide (PDF 256.75 KB)

UnitedHealthcare Dual Complete Preferred (HMO SNP)

Coverage Policy Library

Frequently Asked Questions by Providers

Notice of Medicare Non-Coverage (NOMNC)

Non-Par Provider Appeal/Dispute Rights

TENNderCare

E-alert: Electronic Medical Records and Documentation of Seven (7) Required Components (PDF 16.59 KB)

Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)

(PDF 1.31 MB)

Focus on Health Education Poster (PDF 257.65 KB)

Focus on History, Physical Exam, Vision and Hearing Screenings Poster (PDF 486.37 KB)

Focus on Immunizations Poster (PDF 260.33 KB)

Focus on Lead Poster (PDF 255.48 KB)

Just for Teens website

TENNderCare EPSDT Audit Tool (PDF 101.28 KB)

TENNderCare EPSDT MRR Scoring Manual (PDF 183.4 KB)

TENNderCare Exit Interview Provider Handout (PDF 106.36 KB)

TENNderCare Exit Summary (PDF 76.12 KB)

TENNderCare Guidelines (PDF 32.86 KB)

TENNderCare Tool Kit for UnitedHealthcare Community Plan Physician Partners (PDF 104.71 KB)

TENNderCare Web Site

Tennessee Chapter of the American Association of Pediatrics (TNAAP)

Vaccines for Children FAQ (PDF 28.36 KB)

TNAAP Age Specific Forms for EPSDT exams (PDF 2.94 MB)

Adolescent Preventive Health Tool Resource (PDF 24.96 KB)

Adolescent Health (PDF 20.14 KB)

Childhood Immunizations (PDF 21.31 KB)

Preventive Care (PDF 21.51 KB)

Immunization Schedules
0-6 Years (PDF 186.15 KB)
7-18 Years
(PDF 154.71 KB)Adult Schedule (PDF 281.9 KB)

Quality
IA Program Description (PDF 316.82 KB)
QI Program Evaluation (PDF 728.83 KB)

Manuals and Forms

Provider Manuals

Tennessee Medicaid Administrative Guide (PDF 2.69 MB)

Tennessee Medicare UHC Dual Complete Administrative Guide (PDF 3.8 MB)

Member Handbook (PDF 4.76 MB)

March Vision Provider Reference Guide (PDF 2.1 MB)

March Vision TN Specific Benefit Summary (PDF 28.27 KB)

Forms

Guide to Provider Initiated Notices (PIN) (PDF 67.51 KB)
Universal PIN Form (PDF 35.4 KB)
Universal PIN Electronic Form (PDF 33.19 KB)
Provider Compliance Checklist (PDF 69.37 KB)
Title VI Article (PDF 38.72 KB)
Electronic Payment Authorization/Maintenance Form (PDF 20.63 KB)
Prior Authorization Fax Request Form (PDF 89.93 KB)
Critical Incident Reporting Form (PDF 39.33 KB)
Hysterectomy (PDF 68.03 KB)
Hysterectomy (Español) (PDF 67.7 KB)
Sterilization Consent
Sterilization Consent (Español)
TennCare Disclosures and Medicaid ID Requirements
Medicaid Identification Numbers
Change PCP Request (PDF 51.19 KB)
Provider Dispute Form (PDF 101.79 KB)
Recoup Request Form 2011 (PDF 27.52 KB)
Maternity CM Notification Form (PDF 11.56 KB)
East and Middle Region Medical Necessity Form (PDF 8.79 KB)
West Region Medical Necessity Form (PDF 8.45 KB)
Abortion Necessity Form (PDF 22.14 KB)
Electronic Visit Verification (EVV) Data Collection Form (PDF 99.9 KB)
Provider Requirements Standards Assessment and Documentation Review Form (PDF 44.75 KB)
Panel Status Change Request Form (PDF 80.49 KB)

Behavioral Health

Adverse Occurrence Form (PDF 7.31 KB)
TennCare Pre-Certification & Concurrent Review Fax Form
Discharge Instructions Form (PDF 29.47 KB)
Discharge Plan Requirements (PDF 23.12 KB)
Discharge Summary
(PDF 31.16 KB)

Site Audit Tools (PDF 120.48 KB)
Other Audit Tools (PDF 191.03 KB)
PEP Plan (PDF 248.08 KB)

CHOICES (Long Term Care)

Prior Authorization Fax Form
Provider Application (PDF 96.69 KB)
Provider Change Form (PDF 42.03 KB)

UnitedHealthcare Community Plan (TennCare)

Prior Authorization Fax Form

Bus Pass Exemption Forms

Bus Exemption Form-Brentwood (PDF 35.26 KB)
Bus Exemption Form-Chattanooga (PDF 34.14 KB)
Bus Exemption Form-Kingsport (PDF 34.14 KB)
Bus Exemption Form-Knoxville (PDF 34.12 KB)
Bus Exemption Form-Memphis (PDF 34.12 KB)

UnitedHealthcare Dual Complete (Special Needs Product (SNP)
Medicare Prescription Drug Determination Request Form
Pharmacy Prior Authorization Form
Prior Authorization Fax Form

CPT (Current Procedural Terminology) Codes
Radiology Crosswalk Table (PDF 197.58 KB)
Radiology Prior Authorization List (PDF 200.09 KB)

Utilization Guidelines
Quality Improvement Program Description (PDF 291.08 KB)
Quality Improvement Program Evaluation (PDF 696.96 KB)

Behavioral Health

Site Audit Tools (PDF 120.48 KB)
Other Audit Tools (PDF 163.59 KB)
Provider Evaluation of Performance Plan (PDF 248.08 KB)
Behavioral Health Information/Resources
Primary Care Provider Behavioral Health Screening Toolkit (PDF 175.1 KB)
Behavioral Health Credentialing and Recredentialing Quick Reference Guide
Crisis Services Training Curriculum (TDMH)
Declaration of Mental Health Treatment Information & Forms (TN Government web site)
Division of Alcohol and Drug Abuse Services (DADAS)
TennCare Outpatient BH Certification Inquiry
Tennessee Department of Mental Health (TDMH)
UnitedHealthcare Community Plan Behavioral Health Provider Directory
TDMH Standards Manual
HEDIS Behavioral Health Measures (PDF 39.95 KB)

Behavioral Health Level of Care Guidelines

Substance Abuse and Co-Occurring Disorders

Mental Health, Substance Abuse and Co-Occurring Disorders

United Healthcare Community Plan currently utilizes the following Level of Care Guidelines (LOCGs) to conduct medical necessity reviews of requests for services as they apply to available Behavioral Health benefits.

ASAM PPC-2R criteria are currently utilized for all Substance Abuse services. ASAM criteria are proprietary and cannot be given to providers or members unless a denial of service(s) is rendered, at which time a copy of the criteria in question can be obtained upon request. Providers wishing to access these criteria independently may purchase them using the following link: ASAM PPC-2R (American Society of Addiction Medicine- Patient Placement Criteria, 2nd Revision)

Guidelines currently used for all other levels of care listed below can be found at http://www.uhccommunityplan.com/health-professionals/TN/provider-information

Levels of Care and Services not utilizing ASAM or Milliman Criteria:
Adult Residential Treatment (Adult RTC) (PDF 34.62 KB)
Acute Inpatient Hospitalization (PDF 35.36 KB)
Applied Behavioral Analysis Medical Necessity Guidelines (PDF 35.04 KB)
Assertive Community Treatment (PDF 28.44 KB)
Child and Adolescent Residential Treatment (C&A RTC) (PDF 167.6 KB)
Comprehensive Child and Family Treatment (CCFT) (PDF 34.29 KB)
Continued Service (PDF 28.1 KB)
Continuous Treatment (CTT) (PDF 34.56 KB)
Crisis Stabilization Unit (CSU) (PDF 29.94 KB)
Intensive Outpatient (PDF 110.45 KB)
Level I and II Case Management Services (PDF 31.95 KB)
Nursing Home Plus (PDF 27.71 KB)
Outpatient (PDF 106.19 KB)
Partial Hospital (PHP) (PDF 111.93 KB)
Psych Testing Guidelines (PDF 36.7 KB)
Electroconvulsive Therapy (ECT) (PDF 126.81 KB)
Supported Housing and Enhanced Supported Housing (Combined)
(PDF 35.27 KB)Psychosocial Rehabilitation Community Support Services (PDF 158.86 KB)

Resources

Tennessee False Claims Act (PDF 1.63 MB)
Contractor Risk Agreement - TennCare East and West
Contractor Risk Agreement - TennCare Middle

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.