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UnitedHealthcare Community Plan Lookup Tools

Find A Provider

Search our directory of network physicians and facilities by providing additional information below.

UHC Community Plan of OH Find a Provider

Ohio Department of Medicaid - Find a Provider

OhioRISE - please see below 

Your Primary Care Provider (PCP)

The main doctor you see is called a Primary Care Provider, or PCP. When you see the same PCP over time, it’s easier to develop a relationship with them. Each family member can have their own PCP, or you may all choose to see the same person. You will see your PCP for:

  • Routine care, including yearly checkups
  • Coordinate your care with a specialist
  • Treatment for colds and flu
  • Other health concerns

You have options

You can choose between many types of network providers for your PCP. Some types of PCPs include:

  • Family doctor (also called a general practitioner) — cares for children and adults
  • Internal medicine doctor (also called an internist) — cares for adults
  • Nurse Practitioner (NP) — cares for children and adults
  • Pediatrician — cares for children
  • Physician Assistant (PA) — cares for children and adults

What is a Network Provider?

Network Providers have contracted with UnitedHealthcare Community Plan to care for our members. You don’t need to call us before seeing one of these providers. Sometimes members need to see a very specialized type of doctor. We will work with your PCP to make sure you get the specialist or service when you need it, for as long as you need it, even if the provider is not currently a network provider. There is no cost to you when we authorize the care or service in advance, before you see the non-network provider.

If you see a specialist without being sent by your PCP and without UnitedHealthcare Community Plan authorization in advance advance, you may have to pay the bill. Always work with your PCP first for any services you need.

How to change your PCP

Member Services will help make sure that the PCP you want to switch to is a participating provider with UnitedHealthcare Community Plan. They will also check to be sure the PCP you want to switch to is accepting new patients. Members can change their PCP monthly. 

If you change during your first month of membership, you PCP change will be effective immediately. After your first month of membership, your PCP change will take effect the first day of the next month. We will send you a new ID card with your new PCP listed. We will also let you know when you can start seeing your new PCP. Download the PCP Change form

If you have questions? Visit myuhc.com/CommunityPlan or call Member Services at 1-800-895-2017, TTY 711.

UHC Community Plan of Ohio Provider Directories

OhioRISE

Provider Directory

You can request a printed copy of our provider directory. Just call Member Services at 1-833-711-0773 (TTY: 711).

You can also download a list of Child and Adolescent Needs and Strengths (CANS) providers.

The provider directory is also online at AetnaBetterHealth.com/OhioRISE. Click on the ‘Find a Provider’ ribbon on the top righthand side of the page. From there you can search behavioral health providers, specialists and facilities in your area.

The online provider directory gives the provider’s name, address, telephone numbers, professional credentials, specialty and board certification status.

If you want help finding a provider for any of our services, call Member Services at 1-833-711-0773 (TTY: 711). We will be happy to help you. You also can call Member Services if you want a provider to be added to our network. We will try to make that happen.

You may see an out-of-network provider if you need special care and we do not have a network provider with the right specialty. The provider must first get approval from us to see you, or you may be billed. See pages 13-15 of the Handbook on getting prior approval (prior authorization) for services.

If you are unable to leave your home

If you can’t leave your home to get care, we can help. Call Member Services at 1-833-711-0773 (TTY: 711). We will have a care coordinator work with you to make sure you get the care you need.

If you are experiencing a behaviroal health crisis, please call 1-877-542-9236 (TTY: 711). Calls are answered 24/7. Interpreter service is available.

Search for a behavorial health provider.

OhioRISE

Mobile Response and Stabilization Services (MRSS) is covered by OhioRISE. It provides rapid in-person care when a child or youth is experiencing significant behavioral or emotional distress. It’s available 24 hours a day, 365 days a year, and is delivered in the home, school, or at another location in the community.

This service is available to any child or youth covered by Ohio Medicaid. Call the Ohio CareLine at 1-800-720-9616 to reach the MRSS in your community.

Download a copy of the MRSS provider directory. 

Ohio Community Plan Drug Information

Drug Lists

Brand and/or generic may be excluded from coverage. Lower-cost options are available and covered. Please see the 90 Day Supply Drug List for more information.

COVID 19 Test Kit Reimbursement Request Form

Direct Member Reimbursement Form

OhioRISE Information

Important Update on Prescription Benefits: Ohio Medicaid Single Pharmacy Benefits Manager

Your prescription benefits are provided by a Pharmacy Benefits Manager, or PBM. We partner with Ohio Department of Medicaid to provide this benefit, and on October 1, 2022, we will start to work with a new PBM, Gainwell.  Your pharmacy benefit will remain the same.

For questions about finding a pharmacy in the network, medications or prior authorization, contact Gainwell at spbm.medicaid.ohio.gov or contact them by phone at 1-833-491-0344

You can find Ohio Unified Preferred Drug List here: https://pharmacy.medicaid.ohio.gov/unified-pdl 

You can also access pharmacy information at the Ohio Department of Medicaid website here: https://pharmacy.medicaid.ohio.gov/ or https://medicaid.ohio.gov/families-and-individuals 

Find A Pharmacy

Search for a UnitedHealthcare network pharmacy below.

Search for a Pharmacy.

Due to State Law and Medicaid requirements, members must have a referral from their healthcare provider (physician, nurse practitioner, or physician assistant) before a pharmacist may provide drug therapy management services. The pharmacist must also have an active consulting agreement with the member’s healthcare provider before services may be rendered.

Important Update on Prescription Benefits: Ohio Medicaid Single Pharmacy Benefits Manager

Your prescription benefits are provided by a Pharmacy Benefits Manager, or PBM. We partner with Ohio Department of Medicaid to provide this benefit, and on October 1, 2022, we will start to work with a new PBM, Gainwell.  Your pharmacy benefit will remain the same.

For questions about finding a pharmacy in the network, medications or prior authorization, contact Gainwell at spbm.medicaid.ohio.gov or contact them by phone at 1-833-491-0344

You can find Ohio Unified Preferred Drug List here: https://pharmacy.medicaid.ohio.gov/unified-pdl 

You can also access pharmacy information at the Ohio Department of Medicaid website here: https://pharmacy.medicaid.ohio.gov/ or https://medicaid.ohio.gov/families-and-individuals 

Flu Vaccine Locator

Members can get their flu vaccine at the following pharmacies

Drugs

If your doctor wants you to have a drug that is not on our list, your doctor can request it. Our pharmacy staff looks over the request within 24 hours and makes a decision.

  • If you need drugs right away, the pharmacist can fill a one-time, five-day supply of the drugs not on our Preferred Drug List.
  • If you take the drug on an ongoing basis, the pharmacist can fill a 15-day supply. The pharmacist will have to call UnitedHealthcare Community Plan's pharmacy department for approval.

Medical

In some cases your provider must get permission from the health plan before giving you a certain service. This is called prior authorization. This is your provider’s responsibility. If they do not get prior authorization, you will not be able to get those services.

View our list of services that require prior authorizations.

Learn More

UnitedHealthcare Community Plan