LA Provider Information

We’re Making Changes Based on Your Feedback (PDF 60.03 KB)

Pregnant Members Have Up to Two New Patient Visits per Pregnancy (PDF 37.11 KB) - 9.13.2017

Claim Process Updated for Multiple Gestation Deliveries (PDF 41.88 KB) - 9.13.2017

Documentation Not Required for Obstetric Ultrasounds When Billed with Documented Diagnosis Codes (PDF 37.96 KB) - 9.13.2017

Coverage of Pap Smears for Members Younger Than 21 (PDF 45.58 KB) - Posted 8.24.2017

COB Information on UnitedHealthcare's Provider Portal (PDF 51.17 KB) - Posted 7.21.2017

Restarting Coordination of Benefits and Third Party Liability Claim Recoupment (PDF 42.71 KB) - Posted 4.25.2017

Coordination of Benefits and Third Party Liability Claim Recoupment Process Update 11/2016 (PDF 38.79 KB)

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  

Remittance Advice (RA) Messages Effective 9/1/2016

• By the end of the summer (2016), we will have the ability to include short, informative messages on our RAs, which will serve as a great method to notify providers of claims issues and other important information

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

UnitedHealthcare Community Plan wants to help you make sure your patients are prepared for hurricane season and the resulting hazards such as storm surge, high winds, tornadoes, and flooding. Be sure to share these tips with your patients before disaster strikes:

• Assemble an emergency preparedness kit including: food; water; extra cash; first aid supplies; a flashlight; 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 such as disinfecting bleach; and other essential items. Consider the special needs of family members and supplement kits with items that fit your needs (such as baby supplies or pet food). Be sure to include your UnitedHealthcare Community Plan and Medicaid ID cards.
• Identify ahead of time where to go if you are told to evacuate. Choose several places, such as a friend's home in another town, a motel or a shelter and have their phone numbers on hand. You may need to take unfamiliar routes if major roads are closed or clogged so be sure to have a map. Develop a plan for family communication in the event of an emergency and agree on evacuation routes so everyone knows what to do and where to go.
• Listen to NOAA (www.noaa.gov) Weather Radio or local radio or TV stations for evacuation instructions. If advised to evacuate, do so immediately.You can find more information at https://lava.dhh.louisiana.gov/. There, you can sign up for text updates and even a smartphone application to help you plan. from Louisiana Governor's Off ice and the American Red Cross

• Please encourage your patients to update their address and phone contact information with us regularly so we can reach them in case of an emergency. Members can do this by calling Member Services, 866-675-1607 (TTY: 711) or NurseLine, 877-440-9409.
• If your office relocates or closes for an extended period, please contact us at 877-369-1302.
• In case of a hurricane or other disaster, your patients can register on the American Red Cross Safe and Well website, redcross.org/SafeandWell, to let family and friends know about their welfare.Those without Internet access can call 1-866-GET-INFO.
• Volunteers are critical in an emergency. First-responders and shelter volunteers play a crucial role by donating their time, skills and resources to those in need.
• Visit lsms.org/site/emergencypreparedness for more information.

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

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 hearg 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 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 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-Medicare Notification/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)