UnitedHealthcare Community Plan
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UnitedHealthcare Community Plan of Kansas

We insure more pregnant moms, more children, and more aged, blind and persons with disabilities than anyone else. No one has a larger list of doctors and hospitals. We're a leader in working with community organizations to help the uninsured become insured, and the insured to get the best medical care possible. We're a leader in the effort to understand the social and cultural causes of disease. UnitedHealthcare has been in your community for years. We look forward to partnering with you.

UnitedHealthcare Responds to Ebola Concerns (PDF 80.08 KB)

Issues Log

The Provider Issue Log is updated on a weekly basis and provides the status, resolution and timing of global issues impacting multiple providers. Click here (PDF 1.23 MB) to access the Provider Issue Log.

 

Provider Authorization list for Kansas (PDF 185.96 KB)

I/DD Waiver Implementation

Check back here for key information and updated regarding the inclusion of the I/DD waiver into KanCare.

Continuity of Care Period Ending 10/1/2014

As part of the implementation of the Intellectual and Developmentally Disabled Waiver (I/DD) into the KanCare program, the State of Kansas instituted a continuity of care period. This period was designed to ensure there were no service disruptions by having MCOs waive the need for prior authorizations for the provision of member care through July 31, 2014. UnitedHealthcare has extended that period through the end of September, but please note it will be ending on October 1, 2014, and all I/DD waiver services and targeted case management services will need to have a prior authorization in place for a claim to be approved.

If you have any questions please contact your provider advocate which is listed on our website or call our provider services line at 877-542-9235. Additional information about the program and any subsequent changes may be found at http://www.uhccommunityplan.com/health-professionals/ks.html

Provider After Hour Emergency Line

The Provider After Hour Emergency Number for the I/DD Waiver is 866-211-4570. This number has been established for providers to report urgent issues relative to a member’s I/DD waiver services that occur after standard business hours that effect the immediate health and/or well-being of members on the I/DD Waiver. Medical or life threatening emergencies should be directed to 911.

Providers should leave the member information, including member ID number and spelling of the member name, as well as the nature of the emergency on the confidential voicemail. A member of our Care Coordination staff will receive the information and assist with the emergency situation and follow up with the caller call.

This telephone number should not be used to report issues with claims or authorizations. Issues with claims and authorizations should be directed to your HCBS Provider Advocate.

Provider Training

Access our I/DD Provider Training Schedule for the dates, times and connection information for provider education opportunities: IDD Provider Training Schedule (PDF 326.63 KB)  

Providers may access the presentation/training materials here: IDD Provider Training Presentation
(PDF 3.82 MB)

Questions that were not answered during the I/DD Provider Training Sessions will be posted here (PDF 190.03 KB) with the responses.


Provider Advocate Contact Information

Providers may click here (PDF 115.88 KB) to access the HCBS Provider Advocate Territory Map to identify the Provider Advocate in your area.


United IDD Provider Billing Guidelines

Click here (PDF 129.58 KB) for the current guidelines.
Click here (PDF 196.56 KB) for Atypical Provider Billing Bulletin.

Billing Issues Related to NPI Number
Providers who are experiencing claim issues related to NPI number may click here (PDF 105.34 KB) for suggested steps to follow to help identify and correct the provider NPI issue.

 

UnitedHealthcare Provider Contact List

View details

UnitedHealthcare’s provider support teams are available to assist Kansas Providers. 

Call Center Support

Provider Services Call Center

877-542-9235

Prior Authorization Call Center

866-604-3267

UHCOnline Customer Service (website assistance)

866-842-3278 Option 2

 

Physical Health Providers

Network Team for contracting/credentialing

ks.net.mgmt@uhc.com

Provider Advocate Team

Kansas_PR_Team@uhc.com

Physical Health Provider Advocate Map (PDF 88.71 KB)

 

Behavioral Health/Substance Use Disorder Providers

Customer Care Professional Call Center

855-802-7095

Provider Relations Lead Monica Meek

Monica.meek@optum.com

Fax authorizations or provider concerns

855-268-9392

Sandra K Hashman-Evans, Executive Director

Sandra.hashman@optum.com; 913-333-4051

 

Nursing Facilities

Nursing Facility Provider Support Line

888-823-8751

Mona Hull, Provider Advocate Manager

Mona_hull@uhc.com; 612-642-7797

Michelle Simms, Provider Advocate

Michelle_M_Sims@uhc.com; 913-323-1037

Nursing Facility Provider Advocate Map  (PDF 177.22 KB)

 

Home and Community Based Service Providers

HCBS Provider Support Team Email

Ksunited_longtermcare@uhc.com

Shandy Ricketts, HCBS Network Manager

Krista Hayes, Credentialing/Special Accounts

sricketts@uhc.com; 316-794-2252

kristahayes@uhc.com; 913-333-4013

Jennifer Crawford, Northcentral & Northeast Kansas

Dalia Aguilar, East/Southeast

jennifer_crawford@uhc.com; 785-234-1279


dalia_aguilar@uhc.com; 913-333-4244

Tamara Sands, Western Kansas


Craig Sangals, Southcentral

Tamara_sands@uhc.com; 620-227-2498


craig_sangals@uhc.com; 316-321-1025


Home and Community Based Services Provider Advocate Map 
(PDF 115.88 KB) 


 

Vision Providers

OptiCare Provider Support Center

866-921-7962

 

Pharmacy Providers

OptumRx Help Desk – for pharmacy claim
resolution

877-305-8952

OptumRx Network Management

800-613-3591

Jennifer Murff, Kansas Pharmacy Manager

Jennifer.Murff@uhc.com; 913-333-4002

 

Dental Providers

Provider Services Call Center

855-878-5372

 

Transportation Providers

LogistiCare Provider Support Line

866-697-0492 

 

Provider Administrative Guide

Click here to access the UnitedHealthcare Provider Administrative Guide.

Find A Doctor 

Click here to access Find A Doctor, our online provider search tool.  

Access a pdf Provider Directory:  
     Eastern third of Kansas (PDF 5.36 MB) 
     Middle third of Kansas (PDF 4.84 MB) 
     Western third of Kansas (PDF 3.37 MB)
     HCBS Provider Directory (PDF 5.97 MB)

Medical Injectables

Specialty pharmacy medications covered on the Medical Benefit may be provided through a variety of channels – home infusion provider, outpatient facility, physician, or specialty pharmacy.

For physicians who do not want to buy-and-bill a specialty pharmacy medication that is covered on the Medical Benefit, they may choose to source it through a network specialty pharmacy:

Network Specialty Pharmacy

Phone Number

OptumRx

866-218-7398

BioScrip (offers nursing services)

• also a National Home Infusion Provider for Medical Benefit medications

866-788-7710

The following specialty pharmacies may also provide specific categories of specialty pharmacy medications:

Network Specialty Pharmacy

Medication Category

Phone Number

Accredo (offers nursing services)

Enzyme Deficiency

Gaucher's Disease

Immune Globulin

Pulmonary Hypertension

888-296-4513

 

Walgreens Infusion Services (offers nursing services)

Cardiovascular/Heart Failure

Enzyme Deficiency

Gaucher's Disease

Hemophilia

Immune Globulin

Makena

866-827-8203

CVS Caremark Specialty Pharmacy

Enzyme Deficiency

Gaucher's Disease

Makena

Pulmonary Hypertension

800-237-2767

Coverage of the requested drug is dependent on the member's benefits, and the availability of a specific drug from a network specialty pharmacy may vary.

The Specialty Pharmacy can deliver the medication to the healthcare practitioner's office or another site (ex. patient's home) upon request, and the Specialty Pharmacy will bill the patient's health plan directly.

 

Disclosure forms

Disclosure Forms are required for all contracted providers. If you are already a network provider and have not submitted your completed disclosure form, please email the form to ks.disclosure.forms@uhc.com

Provider Notice Archives

Integrity of Claims, Reports, and Representations to the Government

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.

Medical Policies and Coverage Determination Guidelines for Community Plans

Medical Policies and Coverage Determination Guidelines for Community Plans

Please read the terms and conditions below carefully.

UnitedHealthcare has developed Medical 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. Treating physicians and health care providers are solely responsible for determining what care to provide to their patients. Enrollees should always consult their physician before making any decisions about medical care.

Our Medical Policies express our determination of whether a health service (e.g., test, device or procedure) is proven to be effective based on the published clinical evidence. They are also used to decide whether a given health service is medically necessary. Services determined to be experimental, investigational, unproven, or not medically necessary by the clinical evidence are typically not covered.

Coverage Determination Guidelines are used to determine whether a service falls within a benefit category or is excluded from coverage. Coverage Determination Guidelines may address such matters as whether services are skilled versus custodial, or reconstructive versus cosmetic.

Benefit coverage for health services is determined by the enrollee's specific benefit plan document, such as a Certificate of Coverage, Schedule of Benefits, or Summary Plan Description, and applicable laws that may require coverage for a specific service. The enrollee's benefit plan document identifies which services are covered, which are excluded, and which are subject to limitations. In the event of a conflict, the enrollee's specific benefit document supersedes these policies and guidelines.

Medical Policies and Coverage Determination Guidelines are developed as needed, are regularly reviewed and updated, and are subject to change. They represent a portion of the resources used to support UnitedHealthcare coverage decision making. The information presented in these policies and guidelines is believed to be accurate and current as of the date of publication, and is provided on an "AS IS" basis. Additionally, UnitedHealthcare may use tools developed by third parties, such as the MCGTM Care Guidelines, to assist us in administering health benefits. The MCGTM Care Guidelines are intended to be used in connection with the independent professional medical judgment of a qualified health care provider and do not constitute the practice of medicine or medical advice.

Medical Policies and Coverage Determination Guidelines are the property of UnitedHealthcare. Unauthorized copying, use and distribution of this information are strictly prohibited. The MCGTMCare Guidelines are proprietary to MCGTM and are not published on this website.

When these medical policies are used to determine medical necessity, clinical guidelines will be applied in the following order:

1) State/Federal Guidelines and Contract Requirements
2) UnitedHealthcare Community Plan Medical Policies and Coverage Determination Guidelines
3) Milliman Care Guidelines

For UnitedHealthcare Community Plan Medical Policies and Coverage Determination Guidelines, please click here.

Kansas Department of Health and Environment's Division of Health Care Finance and the Kansas Foundation for Medical Care (KFMC) are working together to assist Medicaid providers in Kansas with implementing health information technology. The documents available at this link describe the services offered and eligibility criteria.

KDHEMU Notice Faxable (PDF 143.32 KB)

KDHEMU Notice For Stakeholder Newsletters (PDF 142.57 KB)