UnitedHealthcare Community Plan
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We continue to ensure that all documents are updated for ICD-10 Terminology. Providers should be aware that ICD-9 content applies to dates of service prior to 10/1/2015. ICD-10 terminology and claims sets apply to dates of service 10/1/2015 and after, regardless of the status of the document. 

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Welcome to the UnitedHealthcare Community Plan Health Professionals area for Louisiana providers! Here you will find the information, forms, manuals and links you need to conduct business with UnitedHealthcare Community Plan.

 

Healthy Louisiana Schedules Flood-related Emergency Response Calls for Providers

This notification is being published at the request of the

Louisiana Department of Health (LDH).

 

 

ATTENTION ALL CARE PROVIDERS IN LOUISIANA

 

Healthy Louisiana schedules flood-related emergency response calls for care providers

 

Beginning Friday Aug. 19, 2016, the Louisiana Department of Health and the Healthy Louisiana plans will host a series of care provider calls to address care provider issues related to the current flood-related emergency situation. These calls are limited to care providers located in or serving areas affected by the recent flooding. 

 

Five calls have been scheduled, each focusing on a specific health plan and their emergency procedures. See below for dates, times and health plan focus. Additional call dates will be added if needed to help ensure timely and effective communication between care providers, the health plans and the Louisiana Department of Health.

 

Non-emergency care provider-related issues should be addressed with the provider relations staff at the appropriate health plan. Non-emergency behavioral health issues should be addressed with the health plan’s provider relations staff or on the regularly scheduled weekly care provider calls. 

 

The first care provider call for UnitedHealthcare Community Plan has been scheduled for: 

 

  • Thursday, August 25, 2016 - UnitedHealthcare Community Plan

                                                                                                                             

The call will take place from noon until 1:30 p.m. The call-in information is as follows:

 

  • Conference Number:  888-557-8511

  • Access Code:  8301342

     

    LDH offers care providers numerous avenues for reporting and resolving issues related to Healthy Louisiana. Please refer to Information Bulletin 12-27 posted on www.makingmedicaidbetter.com. This bulletin also includes contact information for each of the health plans.     

     

    If you are not able to participate on one of the calls and have questions, please contact the Healthy Louisiana plans directly.

     

    If you have questions for Medicaid, please email them to Healthy@la.gov. Thank you.

Louisiana State of Emergency Authorization Requirements

Notice to Providers

 

LOUISIANA: STATE OF EMERGENCY DUE TO HEAVY RAIN AND FLOODING

 

UnitedHealthcare Community Plan is responding to the needs of our members and care providers during this State of Emergency with the following Parishes under a State of Emergency:

 

Acadia, Allen, Ascension, Assumption, Avoyelles, Beauregard, Cameron, Calcasieu, East Baton Rouge, East Feliciana, Evangeline, Iberia, Iberville, Jefferson Davis, Lafayette, Livingston, Point Coupee, St. Charles, St. Helena, St. James, St. John, St. Landry, St. Martin, Tangipahoa, Vernon, St. Tammany, Vermilion, Washington, West Baton Rouge, and West Feliciana.

 

UnitedHealthcare Community Plan of Louisiana has lifted authorization requirements based only on the following criteria for the Parishes listed above for dates of service from Aug. 12, 2016 through Aug 31, 2016: 

 

  • Inpatient emergent admissions will not be denied for late notification, lack of clinical information or lack of notification.

  • Non-emergent admissions will not be denied for lack of prior authorization.

  • Transfer from in-state facility to in-state facility for bed availability will not be denied for lack of prior authorization.

  • Prior authorization for non-emergent services will not be required during the state of emergency.

  • Easing restrictions on prescription refills.

  • Waving prescription co-pays.


Notice to All Durable Medical Equipment, Personal Care Services, PDHC- Pediatric Day Health Care and Private Duty Nursing Care Providers

 

Existing authorizations for services can be extended for members residing in the affected parishes through the end of August without an additional medical necessity review. If a member needs to change care providers because the currently authorized care provider has been affected by the flooding; new clinical information is not be required. The new care provider will be issued an authorization through the end of August.   

 

Note: Please follow standard procedures for any new requests for services that require prior authorization.


For members who do not reside in one of the Parishes listed above, the standard authorization guidelines will apply. Thank you.

 

Important Notices

Third Party Liability (TPL) Process Effective 9/1/2016

Regular and Non-urgent TPL update requests must be sent directly to HMS via one of the methods below:

Fax: 877-204-1325  
Email: latpr@hms.com 
Phone: 877-204-1324

  • Traditional Medicare updates should still be sent to LDH at: 225-342-1376  
  • All Urgent updates, where a member may be in danger of not receiving services (such as prescription refills), should still be sent to the selected Healthy Louisiana Plan.

    UHC Community Plan 
    Customer Service Line: 1-866-675-1607
    Email:
    PI_COB_research@uhc.com

    For more details, please access the LDH Bulletin Notice located at: http://dhh.louisiana.gov/index.cfm/page/1198  

 

Remittance Advice (RA) Messages Effective 9/1/2016

  • By the end of the summer (2016), we will have the ability to include short, informative messages on our RAs, which will serve as a great method to notify providers of claims issues and other important information
Community Plan's "One Call" Resource Line: Provider Services

Dial 866-675-1607 for information regarding:

      Member Eligibility
      Prior Authorization
      Language Interpreter
      Getting Member a Ride
      Referrals to specialists
      Behavioral Health Referral
      Claims Corrections
      Reach a Community - based Case Manager
       and More

Are your Patients Prepared for Hurricane Season?

UnitedHealthcare Community Plan wants to help you make sure your patients are prepared for hurricane season and the resulting hazards such as storm surge, high winds, tornadoes, and flooding. Be sure to share these tips with your patients before disaster strikes:

  • Assemble an emergency preparedness kit including: food; water; extra cash; first aid supplies; a flashlight; a radio; a multi-purpose tool; medications and medical items; copies of personal documents; ID cards; cell phone with chargers; map of the area; an emergency blanket; emergency numbers; sanitation supplies such as disinfecting bleach; and other essential items. Consider the special needs of family members and supplement kits with items that fit your needs (such as baby supplies or pet food). Be sure to include your UnitedHealthcare Community Plan and Medicaid ID cards.
  • Identify ahead of time where to go if you are told to evacuate. Choose several places, such as a friend's home in another town, a motel or a shelter and have their phone numbers on hand. You may need to take unfamiliar routes if major roads are closed or clogged so be sure to have a map. Develop a plan for family communication in the event of an emergency and agree on evacuation routes so everyone knows what to do and where to go.
  • Listen to NOAA (www.noaa.gov) Weather Radio or local radio or TV stations for evacuation instructions. If advised to evacuate, do so immediately.You can find more information at https://lava.dhh.louisiana.gov/. There, you can sign up for text updates and even a smartphone application to help you plan. from Louisiana Governor's Off ice and the American Red Cross
Good to Know:
  • Please encourage your patients to update their address and phone contact information with us regularly so we can reach them in case of an emergency. Members can do this by calling Member Services, 866-675-1607 (TTY: 711) or NurseLine, 877-440-9409.
  • If your office relocates or closes for an extended period, please contact us at 877-369-1302.
  • In case of a hurricane or other disaster, your patients can register on the American Red Cross Safe and Well website, redcross.org/SafeandWell, to let family and friends know about their welfare.Those without Internet access can call 1-866-GET-INFO.
  • Volunteers are critical in an emergency. First-responders and shelter volunteers play a crucial role by donating their time, skills and resources to those in need.
  • Visit lsms.org/site/emergencypreparedness for more information.
Contact Us

Behavioral Health Providers: For instructions on how to join the Behavioral Health Network, to review Community Plan Behavioral Health information, and to submit demographic changes, please click on the Behavioral Health link below.
Community Plan Behavioral Health


Provider Call Center

866-675-1607

Claims Mailing Address
UnitedHealthcare Community Plan
PO Box 31341
Salt Lake City, UT 84131-0341

Utilization Management Appeals Address
UnitedHealthcare Community Plan
Attn: Claims Administrative Appeals
PO Box 31364
Salt Lake City, UT 84131-0364

Claims Appeals Address
UnitedHealthcare Community Plan
Attn: Claims Administrative Appeals
PO Box 31364
Salt Lake City, UT 84131-0364

Credentialing Update: contact the National Credentialing Center at 1-877-842-3210 – Feb. 28, 2012

Grievance Process

UnitedHealthcare Community Plan maintains a grievance system for members that ensures receipt and prompt resolution of informal and formal member grievances and access to the state fair hearg process.

Filing a Member Grievance

A member, a representative of the member's choice, or a CCN-S provider, acting on behalf of the member with the member's written consent, may file a grievance with UnitedHealthcare Community Plan. Grievances may be filed orally by calling the toll-free number for our Member Services Call Center 866-675-1607 or in writing by mailing the grievance to our Regional Mail Operations (RMO) UnitedHealthcare P.O. Box 31364, Salt Lake City, UT 84131-0364. We route telephonic/verbal grievances through our technology that identifies call type and routes to other databases according to category. When the system identifies the call as a grievance, the information is logged into the system, and forwarded to a triage team who puts the information into our tracking system where a case file is created and populated. On receipt of a written grievance, appropriate personnel scan them into the tracking system and create a case file. Per our Member Grievance Policy, and on initial contact, we log and track criteria including member.

 

UnitedHealthcare Community Plan Medical Policies and Coverage Determination Guidelines

 

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.

Healthy Louisiana Medicaid Expansion is Here!

Effective July 1, 2016 new affordable healthcare coverage is available to Louisiana residents thanks to the Healthy Louisiana Program.  

Now, more residents are eligible for Medicaid coverage through the State of Louisiana’s new Medicaid Expansion program.

Who can enroll?

Click here for more information