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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Please select the state where you practice.

Welcome to the UnitedHealthcare Community Plan Health Professionals area for Tennessee providers.

Here, you will find the information and links you need to conduct business with UHC Community Plan. Choose your topic of interest by selecting one of the left navigation buttons.

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, Provider Administrative Manuals and Forms.

Provider Alerts:

Budget Reductions/Impacts for July 1, 2016 (PDF 1.43 MB)

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

Updated Provider Administrative Guide Notice (PDF 47.27 KB)

TennCare Member Re-Verification Information (PDF 351 KB)

Take A Stand Immunization Workshop Opportunity (PDF 198.03 KB)

UnitedHealthcare Clinical Information Submission Protocol (PDF 82.05 KB)

External FAQ Clinical Submission Protocol (PDF 54.21 KB)

Budget Reductions/Impacts Effective July 1, 2015 (PDF 1.48 MB)

Change PCP Request Form (PDF 157 KB)

Transportation Alert (PDF 32.05 KB)

January 1, 2015 MCO Membership Transition Please click Here (PDF 73.21 KB) for important information.

New PCP Assignment Code: Lock In Your Doc (PDF 30.38 KB)

Lock in Your Doc FAQ's (PDF 33.87 KB)

TennCare Drug Safety Alert to Providers (PDF 64.1 KB)

2014 TN 1% Budget Reduction (PDF 308.71 KB)

Enhanced HIPAA Edits Applied to Claim Submissions (PDF 527.71 KB)

Facet Medial Branch Block Injection Certification Form Letter (PDF 140.93 KB)

Facet Medial Branch Injection Certification Form (PDF 282.73 KB)

DentalQuest Announcement (PDF 11.76 KB)

Previous Provider Alerts:

Provider Administrative Guide Notice (PDF 51.21 KB)

Budget Reduction Oct. 1, 2013 (PDF 201.78 KB)
Reimbursement and Member benefits changes (PDF 200.43 KB)  
Attestation form  (PDF 38.29 KB) 
PCP Fee Schedule Increase FAQ  (PDF 24.48 KB) 
PCP Rate Increase Announcement Letter 
(PDF 31.03 KB)Enhanced Rates Allergy and Immunology Clarification (PDF 110.66 KB) 

UnitedHealthcare On Air Is On Demand!

There are a whole lot of changes going on that will affect how you operate your practice.
• Payment Reform and new pay for performance programs
• ICD-10
• Electronic Processing Improvements
• Provider Data Management
• Claims Processing Improvement
• Peer to Peer Best Practices.

Stay in touch through live video updates and emails. Click here to register or login. 

Prior Authorization

Contact Us

Provider Call Center

8 a.m. – 6 p.m., EST

Postal Mailing Address

UnitedHealthcare Community Plan
8 Cadillac Drive, Suite 100
Brentwood, TN 37027

Claims Address   

UnitedHealthcare Community Plan
P.O. Box 5220
Kingston, NY 12402

Utilization Management Appeals Address   

UnitedHealthcare Community Plan
P.O. Box 5220
Kingston, NY 12402

Claims Appeals Mailing Address

Part C Appeals and Grievance Department
UnitedHealthcare Community Plan
Attn: Complaint and Appeals Department
P.O. Box 31364
Salt Lake City, UT 84131-0364


Part D Appeals and Grievance Department
Attn: CA124-0197
P.O. Box 6106
Cypress, CA 90630-9948


CHOICES (Long Term Care)

United Healthcare Community Plan (TennCare)

United Healthcare Dual Complete Preferred (HMO/SNP)

Tools and Resources


Medical Injectables 
To review the clinical criteria/guidelines used to conduct medical necessity reviews, please use this link: https://www.unitedhealthcareonline.com/b2c/CmaAction.do?channelId=ca174ccb4726b010VgnVCM100000c520720a____

CHOICES (Long Term Care) 

UnitedHealthcare Community Plan (TennCare) 
UnitedHealthcare Community Plan Provider Quick Reference Guide (PDF 261.46 KB)

UnitedHealthcare Dual Complete Preferred (HMO SNP) 
Frequently Asked Questions by Providers
Notice of Medicare Non-Coverage (NOMNC)
Non-Par Provider Appeal/Dispute Rights

TennCare Kids
E-alert: Electronic Medical Records and Documentation of Seven (7) Required Components (PDF 18.58 KB) 
Just for Teens website 
TennCare Kids EPSDT Audit Tool (PDF 59.32 KB) 
TennCare Kids EPSDT MRR Scoring Manual (PDF 101.92 KB) 
TennCare Kids Exit Interview Provider Handout (PDF 98.65 KB) 
TennCare Kids Exit Summary (PDF 15.93 KB) 
TennCare Kids Web Site 
Tennessee Chapter of the American Association of Pediatrics (TNAAP) 
TNAAP Age Specific Forms for EPSDT exams (PDF 3.97 MB)   
Childhood Immunizations (PDF 23.32 KB) 

Immunization Schedules
Adult Schedule

2016 HEDIS Expanded Guide (PDF 327.52 KB)
2016 HEDIS Cheat Sheet (PDF 473.36 KB)
2012 QI Program Evaluation (PDF 2.19 MB)
2013 IA Program Description (PDF 405.8 KB)

Documentation Tools
COA Documentationl Tool - Geriatric Form (PDF 249.7 KB)


Provider Manuals

Tennessee Medicaid Administrative Guide (PDF 5.56 MB)
Tennessee Medicare UHC Dual Complete Administrative Guide (PDF 5.09 MB)
Member Handbook (PDF 5.62 MB)
March Vision Provider Reference Guide (PDF 2.12 MB)
March Vision TN Specific Benefit Summary (PDF 142.96 KB)

CPT (Current Procedural Terminology) Codes
Radiology Crosswalk Table
Radiology Prior Authorization List (PDF 242.17 KB)

Utilization Guidelines
Quality Improvement Program Description (PDF 297.65 KB)
Quality Improvement Program Evaluation (PDF 710 KB)


Behavioral Health

Important Reminder for TennCare Behavioral Health Providers: Evaluation and Management Codes for Same-Day Services (PDF 40.27 KB)
Important Reminder for TennCare Behavioral Health Providers: Place of Service Codes
(PDF 48.73 KB)
Important Reminder: TennCare Comprehensive Child & Family Treatment
(PDF 26.15 KB)
Provider Initiated Notice (PIN) Provider Training (PDF 950.5 KB)
ADHD Appointment Planner (PDF 141.26 KB)
ADHD Prescriptions - Importance of Provider Monitoring (PDF 22.65 KB)
ADHD Medication Log (PDF 126.77 KB)
Advance Directives and Living Wills (PDF 603.27 KB)
Adverse Occurrence Form  (PDF 38.01 KB)
Behavioral Health Credentialing and Recredentialing Quick Reference Guide
Behavioral Health Information/Resources

Billing For Family Therapy Codes (PDF 57.11 KB)
Crisis Provider Information for Children and Adolescents (PDF 322.73 KB)
Crisis Services Training Curriculum (TDMH)
Declaration of Mental Health Treatment Information & Forms (TN Government web site) 
Diabetes Training for Mental Health Providers (PDF 221.7 KB)
Discharge Instructions Form  (PDF 31.26 KB)
Discharge Plan Requirements (PDF 25.01 KB)
Discharge Summary (PDF 28.67 KB)
HEDIS Behavioral Health Measures (PDF 9.48 KB)
New Member Rx ADHD (PDF 84.24 KB)
Prior Authorization and Concurrent Review Form  (PDF 46.6 KB)
Primary Care Provider Behavioral Health Screening Toolkit (PDF 42.07 KB)
TennCare Outpatient BH Certification Inquiry
TennCare Pre-Certification & Concurrent Review Fax Form
Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS) 
Tennessee Behavioral Health Quick Reference Guide (PDF 204.88 KB)
UHCCP Facility-Agency Site Audit Tools (PDF 132.24 KB)
UHCCP Member Record Audit Tool  (PDF 245.27 KB)
UHCCP Provider Evaluation of Performance Plan  (PDF 235.3 KB)
UnitedHealthcare Community Plan Behavioral Health Provider Directory

Behavioral Health Level of Care Guidelines

Substance Abuse and Co-Occurring Disorders


Mental Health, Substance Abuse and Co-Occurring Disorders


United Healthcare Community Plan currently utilizes the following Level of Care Guidelines (LOCGs) to conduct medical necessity reviews of requests for services as they apply to available Behavioral Health benefits.

ASAM 3rd Edition criteria are currently utilized for all Substance Abuse services.  ASAM criteria are proprietary and cannot be given to providers or members unless a denial of service(s) is rendered, at which time a copy of the criteria in question can be obtained upon request.  Providers wishing to access these criteria independently may purchase them using the following link: ASAM American Society of Addiction Medicine (American Society of Addiction Medicine- Patient Placement Criteria, 3rd Edition).

Guidelines currently used for all other levels of care listed below can be found at http://www.uhccommunityplan.com/health-professionals/TN/provider-information
Levels of Care and Services not utilizing ASAM or Milliman Criteria:
Adult Level 2 Case Management (PDF 217.22 KB) (PDF 34.96 KB)
Adult Residential Treatment (Adult RTC) (PDF 34.96 KB)
Acute Inpatient Hospitalization (PDF 36.58 KB)
Applied Behavioral Analysis (PDF 44 KB)
Assertive Community Treatment (PDF 31.23 KB)
Child and Adolescent Level 2 Case Management (PDF 218.81 KB)
Child and Adolescent Residential Treatment (C&A RTC) (PDF 36.97 KB)
Comprehensive Child and Family Treatment (CCFT) (PDF 37.59 KB)
Continued Service (PDF 26.7 KB)
Continuous Treatment (CTT) (PDF 42.79 KB)
Crisis Stabilization Unit (CSU) (PDF 32.76 KB)
Intensive Outpatient (PDF 34.51 KB)
(PDF 95.12 KB)Nursing Home Plus (PDF 28.81 KB)
Outpatient (PDF 31.34 KB)
Partial Hospital (PHP) (PDF 41.71 KB)
Psychological & Neuropsychological Testing (PDF 48.9 KB)
Psychosocial Rehabilitation Community Support Services (PDF 60.08 KB)
Sub-Acute Inpatient treatment (PDF 56.67 KB)
Supported Housing and Enhanced Supported Housing (Combined)
(PDF 81.12 KB)


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.


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.