UnitedHealthcare Community Plan
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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.


You’re invited!
LA Community Plan (Bayou Health) Provider Education Webinar UnitedHealthcare Physician, Office Managers and Staff.  (PDF 343.49 KB)

 

 

URGENT ALERT FOR PROVIDERS ON CHANGES IN PRIOR AUTHORIZATION REQUIREMENTS

Provider Alert: Changes to prior authorization requirements for UnitedHealthcare Community Plan of Louisiana members, effective July 1, 2013.

Access the Louisiana Revised Prior Authorization Requirements by clicking .

To help ensure appropriate utilization of specific procedures, effective July 1, 2013 UnitedHealthcare Community Plan of Louisiana will require all physicians to obtain prior authorization for procedures that include, but are not limited to the following:

  • CAT scan
  • MRI
  • Nuclear cardiac imaging
  • Specific vascular  procedures
  • Transplant services
  • Specific surgery of the breast, forehead, eyelids, and  nose
  • Vein stripping
  • Endometrial ablation
  • Non-emergent transfer between facilities

The list was reformulated with the approval of the Louisiana Department of Health & Hospitals. If you have questions, please call 866-604-3267.

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

Provider Call Center

866-675-1607

Claims Address

UnitedHealthcare Community Plan
300 Oxford Drive
Monroeville, PA 15146

Claims Mailing Address

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

Utlization Management Appeals Address

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

Claims Appeals Address

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

Fee Schedules
Fee Schedule (PDF 505.63 KB)
Prior Authorization List
Manuals
Provider Manual (PDF 2.9 MB)
Provider Training Materials

Here, you find the links to our training materials:

UnitedHealthcare Community Plan's Training Materials and Quick Reference Guides that appear on this website apply to both contracted and non contracted providers. If you are not contracted with UnitedHealthcare Community Plan and are a specialist, ancillary provider, or a hospital that participates in the State of Louisiana Medicaid network, you are considered participating with us. The policies and processes that are included in the documents on this website are applicable to all providers, including our contracted PCPs.

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.

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.