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. 

Please select the state where you practice.

UnitedHealthcare Community Plan New Mexico 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

Please Note:
As one of the requirements of Centennial Care, the state is asking for very specific information related to claims encounter submissions.  As such, Providers will be required to bill with the taxonomy code for billing, rendering and/or servicing providers.  UHC piloted this process in early March, however the requirement will be in place for all providers beginning July 1, 2014.  Please make sure your systems are updated to bill with the appropriate taxonomy, NPI and TIN on file with the state.

Contact Information

If you have questions about the UnitedHealthcare Community Plan of New Mexico, Centennial Care, please contact your established Provider Advocate or our Provider Call Center at 888-702-2202, and we will be happy to assist you.

Medical, Behavioral Health and Long-Term Care Services
Customer Call Center

Available 8:00 a.m. to 5:00 p.m.,
Monday through Friday
Customer Call Center: 877‐236‐0826
Customer Call Center TTY: 711

Provider Call Center (Effective 1/1/2014) 
Phone: 888-702-2202

Main Office Address
8220 San Pedro NE, Suite 300
Albuquerque, NM 87113

Medical: 888-702-2202
Behavioral Health: 877-614-0484

Optum RX
Phone: 800‐310‐6826
Fax: 866‐940‐7328

Logisticare (non‐emergent, medically necessary)
Reservations: 866‐913‐2492
Ride Assistance: 866‐913‐2493
Recurring Appointments: 866‐400‐8233
TTY: 866‐288‐3133

United Dental Benefits
Phone: 877‐408‐0159

March Vision
Phone: 888-493-4070 (providers only)

I/T/U Behavioral Health Programs Recredentialing Process (PDF 417.22 KB)

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

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.

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



BioScrip (offers nursing services)

• also a National Home Infusion Provider for Medical Benefit medications


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



Option Care (offers nursing services) 

Cardiovascular/Heart Failure

Enzyme Deficiency

Gaucher's Disease


Immune Globulin



CVS Caremark Specialty Pharmacy

Enzyme Deficiency

Gaucher's Disease


Pulmonary Hypertension


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.


Health Assessment Forms

1) Health Assessment- Child (Under 21) (PDF 566.19 KB)

2) Health Assessment - Adult (21 and over) (PDF 566.05 KB)



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.


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.