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Provider Information

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United Healthcare Community Plan would like to thank each and every health care professional for assisting us in delivering the best possible health care coverage to our most needy community members.  We have enjoyed working with you and will still be available through the end of the year to assist you with any claims questions and/ or issues.  We have also provided the following information for your reference:

DC Plan (PDF 78.96 KB)

DC Provider COC Notice (PDF 71.5 KB)

DC Provider FAQs Plan Phase Down (PDF 96.76 KB)

Important Notice from GOVERNMENT OF THE DISTRICT OF COLUMBIA
Department of Health Care Finance
Health Care Delivery Management Administration

To: District of Columbia Provider Community:

On Thursday, May 2nd, the Executive Office of the Mayor, represented by Deputy Mayor Otero and DHCF held a stakeholder meeting to address concerns around our Managed Care program transition. This session was held to report on the implementation of the new Managed Care contracts and the Administration’s plan to address the issue of unpaid claims by Chartered Health Plan (Chartered). To continue reading the letter, please click here (PDF 152.62 KB).

Medicaid Fee Schedule Recovery Update

We value our partnerships with the medical community and recognize that the recent events related to the changes in the District's Medicaid Fee Schedule have caused frustration for many. We apologize for any difficulty this has caused and effective April 25, 2012, UnitedHealthcare Community Plan ("United") suspended recoveries for claims United overpaid due to the 20% reduction in the District's Medicaid fee schedule.  If you have already paid United based on a letter and 1/1/11-10/31/11 claims detail you received from its Recovery Services, United will refund these payments to you within the next thirty (30) to 45 business days. United is planning a Provider Town Hall here in the District for the week of May 21 to discuss the status of its Medicaid fee schedule implementation. You will receive a invitation directly from United in the very near future. Click here (PDF 68.38 KB) for a Town Hall invitation.

Provider Administration Manual (PDF 1.03 MB)

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____

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 38.15 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.