Welcome to the UnitedHealthcare Community Plan Health Professionals area for North Carolina providers! Here you will find the information, forms, manuals and links you need to conduct business with UnitedHealthcare Community Plan.
Dual Plan (RPPO-SNP) coming soon, learn more >
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.
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.