UnitedHealthcare Community Plan
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UnitedHealthcare Community Plan Michigan Providers

Welcome to the UnitedHealthcare Community Plan Health Professionals area for Michigan providers!

Here you will find the information, forms, manuals and links you need to conduct business with UnitedHealthcare Community Plan.

Please choose your topic of interest, by selecting one of the navigation buttons on the left-hand side of the page, or select one of the topics or products below to reveal our Contact Information.

UnitedHealthcare Community Plan Added to Electronic Payments & Statements (PDF 59.89 KB)

Contact Us:

Medicaid/Healthy Michigan/Children Special Health Care Services (CSHCS)

Provider Call Center

 

800-903-5253
Monday-Friday  8:30 a.m. – 5:30 p.m. EST

 

Claims Mailing Address

 

UnitedHealthcare Community Plan
P.O. Box 30991
Salt Lake City, UT 84130-0991

Payer ID: 95467
 

Member and Provider Complaints and Appeals Address

 

UnitedHealthcare Community Plan
Attn: Complaint and Appeals 
P.O. Box 30991
Salt Lake City, UT 84130-0991

 

Overbilling and Refund Address

 

UnitedHealthcare Community Plan
P.O. Box 740804
Atlanta, GA 30374

 

Dental - Healthy Michigan Plan Only

UHC Dental Provider Services

To verify eligibility, benefits, obtain claim and prior authorization status
855-918-2265

 

 

Interactive Voice Response (IVR)

available 24 hours a day, 7 days a week

 

 

 

Claims Mailing Address

 

UnitedHealthcare MI Dental
P.O. Box 1317
Milwaukee, WI 53201

 

Prior Authorizations

 

UnitedHealthcare MI Dental
P.O. Box 1484
Milwaukee, WI 53201

 

Claims Dispute for Providers

 

UnitedHealthcare MI Dental
Attn_ Appeals Department
P.O. Box 1337
Milwaukee, WI 53201

 

Correspondence regarding your participation, contractual issues, dentist changes or office changes

 

UnitedHealthcare Dental
Provider Relations
6220 Old Dobbin Lane
Columbia, MD 20045

 

Overbilling and Refund Address

 

UnitedHealthcare Community Plan
P.O. Box 740804
Atlanta, GA 30374

 

MIChild

Provider Call Center

 

800-903-5253
Monday-Friday  8:30 a.m. – 5:30 p.m. EST

 

Claims Mailing Address

 

UnitedHealthcare Community Plan
P.O. Box 30991
Salt Lake City, UT 84130-0991

Payer ID: 95467
 

Member and Provider Complaints and Appeals Address

 

UnitedHealthcare Community Plan
Attn: Complaint and Appeals 
P.O. Box 30991
Salt Lake City, UT 84130-0991

 

Overbilling and Refund Address

 

UnitedHealthcare Community Plan
P.O. Box 740804
Atlanta, GA 30374

 

 

 

Provider Credentialing Department Information

Join Our Network:

UnitedHealthcare Community Plan encourages qualified physicians and health care professionals to consider applying to join our participating provider network. Call 1-877-842-3210 to learn more. 

 

 

 

Specialty Pharmacy

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


800-803-2523

 

Option Care (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.

 

 

Healthy Michigan Plan Information for Providers:

Below you will find important information around the Healthy Michigan Health Risk Assessment and copays requirements.

Healthy Michigan Plan Health Risk Assessment FAQ (PDF 33.79 KB)

Health Risk Assessment (PDF 287.55 KB)

SOS L14-52 Letter - Healthy Michigan Plan Copays Policy (PDF 241.58 KB)

Information about Healthy Michigan copays (PDF 134 KB)

file

 

Provider Links

 

Looking for a network care provider?
View our online Provider Directory

Childhood Immunization and Well Child Visits

UnitedHealthcare has identified a performance improvement team to improve Child Immunization and Well Child Visit rates. Click here for detail information.

HEDIS

The Healthcare Effectiveness Data and Information Set (HEDIS®) is a tool used by health plans to measure performance on important dimensions of care and service. Click the guides below to view HEDIS in a Box Quick Reference Guides:

     - PCP All Preventive 
     - PCP All Disease Management 
     - Preventive Child Adolescent  
     - Women's Health for OBGyns

Mental Health

Find out more about depression management and primary care by clicking here.

Obesity Management

Click here to view Key facts about obesity in the United States.

PCP Developmental Surveillance and Screening
Click here to find out about the implementation of standardized developmental screenings through Assuring Better Child Health and Development (ABCD) Academy.

Behavioral Health Service Models

Please visit the following links to view information about evidence-based behavioral health service models for primary care providers.

Screening, Brief Intervention, and Referral to Treatment (SBIRT): Opportunities for Implementation and Points for Consideration

Substance Abuse and Mental Health Services Administration (SAMHSA)/Health Resources and Services Administration (HRSA): A Quick Start Guide to Behavioral Health Integration for Safety-Net Primary Care Providers


Provider Toolkits


Michigan Department of Health & Human Services HPV Recommendations  


The Alliance for immunizations in Michigan (AIM) publishes a Provider Toolkit annually with support from Michigan health plans. The Providers Immunization Toolkit for Children & Adults is a resource guide containing the most current standards of practice, forms, & vaccination methodologies for immunization in Michigan. To find out more, click here.

Provider Chlamydia Toolkit

There is a national increase in the rate of chlamydia.  In an effort to increase the rate at which sexually active women ages 16 to 25 are routinely screened for this sexually transmitted disease, we offer our provider partners a Chlamydia Toolkit.  The Chlmydia Toolkit provides clinical guidelines for the treatment of chlamydia, links to policies and procedures for adoption by your practice to improve routine screening and many more valuable references.  Please visit the following link to download a copy. 

https://www.stratishealth.org/pip/documents/Chlamydia_Toolkit.pdf

Quality Improvement Program

The purpose of the Quality Improvement Program is to achieve desired performance outcomes. UnitedHealthcare Community Plan's Building the Bridge to Excellence QI Program is guided by important objectives. Find out more by clicking here.

Smoking Cessation

UnitedHealthcare Community Plan's Smoking Cessation Program is supported by both behavioral modification and pharmaceutical assistance to effect maximum support for members who are ready to quit. Click here for details.

 

Provider Links

Childhood Immunization and Well Child Visits

 

UnitedHealthcare has identified a performance improvement team to improve Child Immunization and Well Child Visit rates. Click here for detail information.

 

HEDIS

The Healthcare Effectiveness Data and Information Set (HEDIS®) is a tool used by health plans to measure performance on important dimensions of care and service. Click the guides below to view HEDIS in a Box Quick Reference Guides:

     - PCP All Preventive 
     - PCP All Disease Management 
     - Preventive Child Adolescent  
     - Women's Health for OBGyns

Mental Health

 

Find out more about depression management and primary care by clicking here.

 

 

Obesity Management

 

Click here to view Key facts about obesity in the United States.

 

PCP Developmental Surveillance and Screening
Click here to find out about the implementation of standardized developmental screenings through Assuring Better Child Health and Development (ABCD) Academy.

 

Provider Toolkits

 

The Alliance for immunizations in Michigan (AIM) publishes a Provider Toolkit annually with support from Michigan health plans. The Providers Immunization Toolkit for Children & Adults is a resource guide containing the most current standards of practice, forms, & vaccination methodologies for immunization in Michigan. To find out more, click here.

 

Provider Chlamydia Toolkit

 

There is a national increase in the rate of chlamydia.  In an effort to increase the rate at which sexually active women ages 16 to 25 are routinely screened for this sexually transmitted disease, we offer our provider partners a Chlamydia Toolkit.  The Chlmydia Toolkit provides clinical guidelines for the treatment of chlamydia, links to policies and procedures for adoption by your practice to improve routine screening and many more valuable references.  Please visit the following link to download a copy. 

 

https://www.stratishealth.org/pip/documents/Chlamydia_Toolkit.pdf

Quality Improvement Program

 

The purpose of the Quality Improvement Program is to achieve desired performance outcomes. UnitedHealthcare Community Plan's Building the Bridge to Excellence QI Program is guided by important objectives. Find out more by clicking here.

 

Smoking Cessation

 

UnitedHealthcare Community Plan's Smoking Cessation Program is supported by both behavioral modification and pharmaceutical assistance to effect maximum support for members who are ready to quit. Click here for details.

 

 

Provider Links

Childhood Immunization and Well Child Visits

 

UnitedHealthcare has identified a performance improvement team to improve Child Immunization and Well Child Visit rates. Click here for detail information.

 

 

HEDIS

 

The Healthcare Effectiveness Data and Information Set (HEDIS®) is a tool used by health plans to measure performance on important dimensions of care and service. Click the guides below to view HEDIS in a Box Quick Reference Guides:

 

     - PCP All Preventive 
     - PCP All Disease Management 
     - Preventive Child Adolescent  
     - Women's Health for OBGyns

 

 

Mental Health

 

Find out more about depression management and primary care by clicking here.

 

 

Obesity Management

 

Click here to view Key facts about obesity in the United States.

PCP Developmental Surveillance and Screening
Click here to find out about the implementation of standardized developmental screenings through Assuring Better Child Health and Development (ABCD) Academy.

Provider Toolkits

The Alliance for immunizations in Michigan (AIM) publishes a Provider Toolkit annually with support from Michigan health plans. The Providers Immunization Toolkit for Children & Adults is a resource guide containing the most current standards of practice, forms, & vaccination methodologies for immunization in Michigan. To find out more, click here.

Provider Chlamydia Toolkit

 

There is a national increase in the rate of chlamydia.  In an effort to increase the rate at which sexually active women ages 16 to 25 are routinely screened for this sexually transmitted disease, we offer our provider partners a Chlamydia Toolkit.  The Chlmydia Toolkit provides clinical guidelines for the treatment of chlamydia, links to policies and procedures for adoption by your practice to improve routine screening and many more valuable references.  Please visit the following link to download a copy. 

 

https://www.stratishealth.org/pip/documents/Chlamydia_Toolkit.pdf

Quality Improvement Program

The purpose of the Quality Improvement Program is to achieve desired performance outcomes. UnitedHealthcare Community Plan's Building the Bridge to Excellence QI Program is guided by important objectives. Find out more by clicking here.

Smoking Cessation

UnitedHealthcare Community Plan's Smoking Cessation Program is supported by both behavioral modification and pharmaceutical assistance to effect maximum support for members who are ready to quit. Click here for details.

 

 

Medical Policies and Coverage Determination Guidelines

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.