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UnitedHealthcare Community Plan Massachusetts Providers

You don't have time to spare: that's why we put all the documents you need in one place. Use the navigation items on the left to find what you're looking for fast.

 

To report health care Fraud, Waste and Abuse, contact us at 844-359-7736 or uhc.com/fraud.

 

HIPAA Claim Edits

UnitedHealthcare applies HIPAA edits to professional (837p) and Institutional (837i) claims submitted electronically. Visit the EDI Claim Edits page for more information including a complete list of edits, edits related to ICD-10 codes and applicable payers. Claims that reject for HIPAA edits will appear on a clearinghouse level report, enabling you to Identify and correct rejected Information prior to UnitedHealthcare receiving the claim.

 

 

UnitedHealthcare Community Plan Medical & Drug Policies and Coverage Determination Guidelines

UnitedHealthcare has developed Medical Policies, Medical Benefit 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.
View the guidelines

UnitedHealthcare Medicare Advantage Coverage Summaries

For policy guidance for Medicare Advantage plan members, view the UnitedHealthcare Medicare Advantage Coverage Summaries Manual and corresponding policy update bulletins 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. 
View our policy (PDF 38.15 KB).

Disclaimer

If UHG 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.