As of January 1st, 2018 UnitedHealthcare Community Plan will no longer provide Medicaid and Long Term Care coverage in Delaware.   For questions about 2018 services, members can call their new Health Plan Member Service’s phone number, it is on their ID card. If members have questions related to any services prior to January 1, 2018, members can call United Healthcare Community Plan member services at 1-877-877-8159

This change doesn’t affect UnitedHealthcare Medicare, including Institutional Special Needs Plan (I-SNP) and Dual Complete Plan (DSNP) or UnitedHealthcare Commercial Plan members.

Healthcare Providers can continue to call Provider Services at 1-800-600-9007.  For questions regarding behavioral health, please call 1-877-614-0484.  For questions regarding Dental, please call 1-855-609-5152.

Please select the state where you practice.

Claims Reconsideration and Appeals 

 

Claims Reconsiderations/Adjustments

To view up to date Claim Reconsideration information go to UHCprovider.com.

 

Claim Administrative Disputes/Appeals

If you are not satisfied with the outcome of a Claim Reconsideration Request, you may submit a formal Claim Dispute/Appeal using the process outlined in your provider manual.

A formal Claim Dispute/Appeal is a comprehensive review of the disputed claim(s), and may involve a review of additional administrative or medical records by a clinician or other personnel.

UnitedHealthcare Community Plan generally completes the review within 30 calendar days. However, depending on the nature of the review, a decision may take up to 60 days from the receipt of the claim dispute documentation. We will contact you if we believe it will take longer than 30 days to render a decision.

Please allow 10 business days from the submission date to enable us to begin processing the review before requesting a status update.

Additional state requirements may apply. Consult the applicable state Provider Administrative Guide or Manual for more details.

For more information please contact the provider services center.