UnitedHealthcare Community Plan
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Welcome to the UnitedHealthcare Community Plan Health Professionals area for Texas 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, Provider Administrative Manuals and Forms.

 

Contact Us (CHIP)

Provider Call Center

888-887-9003
Monday-Friday  8 a.m. – 5 p.m. CST

 

 

Postal Mailing Address

UnitedHealthcare Community Plan
9702 Bissonnet
Suite 2200W
Houston, TX 77036-8000
 

Claims Mailing Address

UnitedHealthcare Community Plan
PO Box 5270
Kingston, NY 12402-5270


 

Member and Provider Complaints and Appeals Address

UnitedHealthcare Community Plan
Attn:  Complaint and Appeals Dept.
PO Box 31364
Salt Lake City, UT 84131-0364

Overbilling and Refund Address

UnitedHealthcare Community Plan
PO Box 740800
Atlanta, GA 30374

Contact Us (STAR)

Provider Call Center

888-887-9003
Monday-Friday  8 a.m. – 5 p.m. CST

Mailing Address

UnitedHealthcare Community Plan
9702 Bissonnet
Suite 2200W
Houston, TX 77036-8000
 

Claims Mailing Address

UnitedHealthcare Community Plan
PO Box 5270
Kingston, NY 12402-5270
 

Member and Provider Complaints and Appeals     
Address 

UnitedHealthcare Community Plan
Attn:  Complaint and Appeals Dept.
PO Box 31364
Salt Lake City, UT 84131-0364
 

Overbilling and Refund Address

UnitedHealthcare Community Plan
PO Box 740800
Atlanta, GA 30374

Contact Us (STAR+PLUS)

Provider Call Center

888-887-9003
Monday-Friday, 8 a.m. – 5 p.m. CST 

Postal Mailing Address

UnitedHealthcare Community Plan
9702 Bissonnet
Suite 2200W
Houston, TX 77036-8000
 

Claims Mailing Address

UnitedHealthcare Community Plan
CLAIMS
PO Box 31352
Salt Lake City, UT 84131-0352
 

Provider Appeals and Complaints Address           

UnitedHealthcare Community Plan
Attn: Complaint and Appeals Dept.
PO Box 31364
Salt Lake City, UT 84131-0364
 

Overbilling and Refund Address

UnitedHealthcare Community Plan
PO Box 740800
Atlanta, GA 30374

Join Our Network

Click here to learn more about our network. 

Training Presentations

For training information, click here

 

 

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.

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.

 

Disclaimer

If UHG Medical 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.