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Care provider content is now available on UHCprovider.com and will retire from UHCCommunityPlan.com later this year. For more information, visit UHCprovider.com/CommunityPlan.

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UnitedHealthcare Community Plan Louisiana Providers

Welcome!

Welcome to the UnitedHealthcare Community Plan Health Professionals area for Louisiana providers! Here you will find the information, forms, manuals and links you need to conduct business with UnitedHealthcare Community Plan.

 

UnitedHealthcare Community Plan 2015 Contract and Amendments for Healthy Louisiana

The latest version/s of the United Healthcare Community Plan 2015 Contract and Amendments of the Healthy Louisiana contract is available on the Louisiana Department of Health website

View the UnitedHealthcare Community Plan 2015 Contract and Amendments.

Third Party Liability (TPL) Process - Effective 9/1/2016

Regular and non-urgent TPL update requests must be sent directly to HMS via one of the methods below:

Fax: 877-204-1325  
Email: latpr@hms.com 
Phone: 877-204-1324

  • Traditional Medicare updates should still be sent to LDH at: 225-342-1376  
  • All Urgent updates, where a member may be in danger of not receiving services (such as prescription refills), should still be sent to the selected Healthy Louisiana Plan.

    UHC Community Plan 
    Customer Service Line: 1-866-675-1607
    Email: PI_COB_research@uhc.com

    For more details, please access the LDH Bulletin Notice located at: http://dhh.louisiana.gov/index.cfm/page/1198  

Dial 866-675-1607 for information regarding:

      Member Eligibility
      Prior Authorization
      Language Interpreter
      Getting Member a Ride
      Referrals to specialists
      Behavioral Health Referral
      Claims Corrections
      Reach a Community - based Case Manager
       and More

Behavioral Health Providers: For instructions on how to join the Behavioral Health Network, to review Community Plan Behavioral Health information, and to submit demographic changes, please click on the Behavioral Health link below.
Community Plan Behavioral Health


Provider Call Center

866-675-1607

Claims Mailing Address
UnitedHealthcare Community Plan
PO Box 31341
Salt Lake City, UT 84131-0341

Utilization Management Appeals Address
UnitedHealthcare Community Plan
Attn: Claims Administrative Appeals
PO Box 31364
Salt Lake City, UT 84131-0364

Claims Appeals Address
UnitedHealthcare Community Plan
Attn: Claims Administrative Appeals
PO Box 31364
Salt Lake City, UT 84131-0364

Credentialing Update: contact the National Credentialing Center at 1-877-842-3210 – Feb. 28, 2012

Report Health Care Fraud, Waste and Abuse: 844-359-7736 or uhc.com/fraud

We want to help make sure your patients are prepared for hurricane season and the resulting hazards such as storm surge, high winds, tornadoes, and flooding. 

Tips for the Louisiana Governor's Office and the American Red Cross

  • Update Contact Information: Encourage your patients to regularly update their address and phone contact information, so they can be reached in case of an emergency. 
    • Members can contact UnitedHealthcare Community Plan Member Services at 1-866-675-1607 (TTY: 711) or contact the NurseLine at 1-877-440-9409.
  • Assemble an Emergency Preparedness Kit:  Put an emergency kit together and include your UnitedHealthcare Community Plan and Medicaid ID cards. 
    • Kits should include: non-perishable food, water, extra cash, first aid supplies, a flashlight, batteries, a radio, a multi-purpose tool, medications and medical items, copies of personal documents, ID cards, cell phone with chargers, map of the area, an emergency blanket, emergency numbers, sanitation supplies, and other essential items. 
    • Think about the special needs of family members and pets and include items such as baby supplies or pet food. 
  • Prepare and Plan for an Evacuation: Before an emergency happens, think about where to go if you are told to evacuate. Make sure you have a couple of places that you can go, such as a friend's home in another town, a motel or a shelter. 
    • Make sure to have the phone numbers of family and friends with you. It's helpful to have these numbers written down in case you don't have power for your mobile phone or you need to use a landline to make phone calls.
    • Make sure to have a paper map because you may need to take unfamiliar routes if major roads are closed or clogged. 
    • Develop a plan on how you will communicate with family and friends in an emergency. Agree on and share your evacuation routes so everyone knows where to go and what to do.
  • Stay Informed: Listen to NOAA weather radio, local radio stations or TV stations for evacuation instructions. 
    • If you are told to evacuate, do so immediately. 

You can find more information at the Louisiana Department of Health's Louisiana Volunteers in Action (LAVA).

In case of a hurricane or other disaster, your patients can register on the American Red Cross Safe and Well website to let family and friends know about their welfare. Those without Internet access can call 1-866-GET-INFO.

UnitedHealthcare Community Plan maintains a grievance system for members that ensures receipt and prompt resolution of informal and formal member grievances and access to the state fair hearing process.

Filing a Member Grievance

A member, a representative of the member's choice, or a CCN-S provider, acting on behalf of the member with the member's written consent, may file a grievance with UnitedHealthcare Community Plan. Grievances may be filed orally by calling the toll-free number for our Member Services Call Center 866-675-1607 or in writing by mailing the grievance to our Regional Mail Operations (RMO) UnitedHealthcare P.O. Box 31364, Salt Lake City, UT 84131-0364. We route telephonic/verbal grievances through our technology that identifies call type and routes to other databases according to category. When the system identifies the call as a grievance, the information is logged into the system, and forwarded to a triage team who puts the information into our tracking system where a case file is created and populated. On receipt of a written grievance, appropriate personnel scan them into the tracking system and create a case file. Per our Member Grievance Policy, and on initial contact, we log and track criteria including member.

UnitedHealthcare Community Plan Prior Authorization LA - Effective 1/1/2018 (PDF 203.89 KB)

UnitedHealthcare Medicare Solutions and UnitedHealthcare Community Plan (Dual Special Needs Plan) Prior Authorization Requirements - Effective 1/1/2018 (PDF 282.37 KB)

 

UnitedHealthcare Community Plan Prior Authorization LA - Effective 10/1/2017  (PDF 206.62 KB)

UnitedHealthcare Medicare Solutions and UnitedHealthcare Community Plan (Dual Special Needs Plan) Prior Authorization Requirements - Effective 10/1/2017 (PDF 286.74 KB)

UnitedHealthcare Community Plan Prior Authorization LA - Effective 7/1/2017 

UnitedHealthcare Medicare Solutions and UnitedHealthcare Community Plan (Dual Special Needs Plan) Prior Authorization Requirements - Effective 7/1/2017 (PDF 300.09 KB)

UnitedHealthcare Community Plan Prior Authorization LA - Effective 4/1/2017 (PDF 205.2 KB)

UnitedHealthcare Medicare Solutions and UnitedHealthcare Community Plan-Medicare Notification/Prior Authorization Requirements - Effective 5/1/2017 (PDF 299.55 KB)

UnitedHealthcare Medicare Solutions and UnitedHealthcare Community Plan-Medicare Notification/Prior Authorization Requirements - Effective 1/1/2017 (PDF 306.96 KB)

UnitedHealthcare Medicare Solutions and UnitedHealthcare Community Plan-Medicare Notification/Prior Authorization Requirements - Effective 4/1/2017 (PDF 300.79 KB)

UnitedHealthcare Community Plan Prior Authorization LA - Effective 1/1/2017 (PDF 184.83 KB)

UnitedHealthcare Community Plan Prior Authorization List LA - Effective 10/1/2016 (PDF 187.39 KB)

UnitedHealthcare Community Plan Prior Authorization List LA - Effective 5/1/2016 (PDF 202.2 KB)

Prior Authorization (PDF 197.62 KB) - Effective January 1, 2016

Advanced Notification Requirements for LA - Effective June 1, 2015 (PDF 159.88 KB)

Advanced Notification Requirements for LA - Effective February 1, 2015 (PDF 159.68 KB)

 

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).

Reporting Fraud, Waste and Abuse

If you suspect another provider or member has committed fraud, waste or abuse, you have a responsibility and a right to report it.

Call us at: 1-866-675-1607 to report any issues or concerns. 

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.