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Planong Pangkomunidad ng UnitedHealthcare
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 below.

Medicaid Managed Care Rule External FAQ’s (PDF 64.57 KB)

Medicaid Managed Care Rule Presentation (PDF 90.71 KB)

 

Makipag-ugnayan sa Amin

Select a plan below for contact information (call center, mailing address and more).

 

Customer Service:  888-887-9003

Provider Relations: 888-303-6162 or providerservicestx@uhc.com

Customer Service for Long Term Services and Supports:  888-787-4107  or uhc_cp_prov_relations@uhc.com

STAR Kids Service Coordination Hotline:  877-352-7798

STAR+PLUS Service Coordination Hotline: 800-349-0550

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


NurseLine

  • CHIP:  800-850-1267
  • STAR: 800-535-6714
  • STAR+PLUS: 877-839-5407
  • Dual Eligible Members: 877-596-3258

 

 

 

Texas Medicare-Medicaid Plan Logo

Provider Call Center

888-887-9003
Monday-Friday, 8 a.m. – 6 p.m. CST 

Postal Mailing Address

Planong Pangkomunidad ng UnitedHealthcare
14141 Southwest Freeway
Suite 800
Sugar Land, TX 77478
 

Medical Claims Mailing Address UnitedHealthcare Connected
P.O. Box 31352Salt Lake City, UT 84131-0352
 
Provider Grievances Address           

UnitedHealthcare Connected
PO Box 31364
Salt Lake City, UT 84131-0364
 

Overbilling and Refund Address

Planong Pangkomunidad ng UnitedHealthcare
PO Box 740804
Atlanta, GA 30374

Service Delivery Areas

Harris County, Texas

TX Chip logo

Provider Call Center

 

888-887-9003
Monday-Friday  8 a.m. – 6 p.m. CST

 

Postal Mailing Address

 

 

Planong Pangkomunidad ng UnitedHealthcare
14141 Southwest Freeway
Suite 800
Sugar Land, TX 77478

 

Claims Mailing Address

 

 

Planong Pangkomunidad ng UnitedHealthcare
PO Box 5270
Kingston, NY 12402-5270

 

Member and Provider
Complaints and Appeals Address

 

 

Planong Pangkomunidad ng UnitedHealthcare
Paunawa:  Complaint and Appeals Dept.
PO Box 31364
Salt Lake City, UT 84131-0364

 

Overbilling and Refund Address

 

Planong Pangkomunidad ng UnitedHealthcare
PO Box 740804
Atlanta, GA 30374

 

Service Delivery Areas Jefferson and Harris

Texas Star Logo

Provider Call Center

 

888-887-9003
Monday-Friday  8 a.m. – 6 p.m. CST

Mailing Address

Planong Pangkomunidad ng UnitedHealthcare
14141 Southwest Freeway
Suite 800
Sugar Land, TX 77478
 

Claims Mailing Address

Planong Pangkomunidad ng UnitedHealthcare
PO Box 5270
Kingston, NY 12402-5270
 

Member and Provider Complaints and Appeals     
Address 

Planong Pangkomunidad ng UnitedHealthcare
Paunawa:  Complaint and Appeals Dept.
PO Box 31364
Salt Lake City, UT 84131-0364
 

Overbilling and Refund Address

Planong Pangkomunidad ng UnitedHealthcare
PO Box 740804
Atlanta, GA 30374

Service Delivery Areas Jefferson, Harris and Hidalgo


TX Star Plus Logo
Provider Call Center

888-887-9003
Monday-Friday, 8 a.m. – 6 p.m. CST

Postal Mailing Address

Planong Pangkomunidad ng UnitedHealthcare
14141 Southwest Freeway
Suite 800
Sugar Land, TX 77478

Claims Mailing Address

Planong Pangkomunidad ng UnitedHealthcare
MGA PAGHAHABOL
PO Box 31352
Salt Lake City, UT 84131-0352

Provider Appeals and Complaints Address           

Planong Pangkomunidad ng UnitedHealthcare
Paunawa: Complaint and Appeals Dept.
PO Box 31364
Salt Lake City, UT 84131-0364

Overbilling and Refund Address

Planong Pangkomunidad ng UnitedHealthcare
PO Box 740804
Atlanta, GA 30374

Service Delivery Area

Jefferson, Harris, Nueces,
Travis and Central Medicaid
|Rural Service Area (MRSA)
and Northeast MRSA

 

Texas Star Kids Logo

Provider Call Center

888-887-9003
Monday-Friday, 8 a.m. – 6 p.m. CST 

Postal Mailing Address

Planong Pangkomunidad ng UnitedHealthcare
14141 Southwest Freeway
Suite 800
Sugar Land, TX 77478
 

Medical Claims Mailing Address

Planong Pangkomunidad ng UnitedHealthcare
PO Box 5290
Kingston, NY 12402-5290
 

Provider Appeals and Complaints Address           

Planong Pangkomunidad ng UnitedHealthcare
Paunawa: Complaint and Appeals Dept.
PO Box 31364
Salt Lake City, UT 84131-0364
 

Overbilling and Refund Address

Planong Pangkomunidad ng UnitedHealthcare
PO Box 740804
Atlanta, GA 30374

Service Delivery Areas

Jefferson, Harris, Hidalgo
Medicaid Rural Service Area (MRSA Central) and MRSA Northeast

 

Join Our Network

Learn more about our network (PDF 364.56 KB). - Posted 3.28.2016

 

Messages from Texas Health and Human Services

Help Stop Medicaid Fraud (PDF 132.12 KB) - 10.17.2017 

Register Now for Fall 2017 EVV Stakeholder Meetings - 10.3.2017

Zika Mosquito Repellent Benefit Extended to December 2017 (PDF 70 KB) - 9.19.2017

2017/2018 Texas Medicaid Zika Standing Order  (PDF 101.09 KB)- 9.19.2017

Notice to Prescribers: Mosquito Repellent Benefit (PDF 64.94 KB) - 9.19.2017

Zika Mosquito Repellent Benefit: Member Education for You (PDF 64.76 KB) - 9.19.2017

Zika CareConnect Fact Sheet (PDF 331.37 KB) - 9.19.2017

Zika CareConnect Frequently Asked Questions (PDF 210.95 KB) - 9.19.2017

Benefit Update for Early Childhood Intervention for Texas Medicaid Effective September 1, 2017 - 9.11.2017

Texas Health and Human Services Message: Use EVV Reason Code 130 if Affected by Hurricane Harvey (PDF 39.81 KB) - 8.28.2017

Physical, Occupational, and Speech Therapy Benefits for All Ages to Change for Texas Medicaid September 1, 2017 - 7.31.2017

Provider Letter: Pre-admission Screening and Resident Reviews and the QSR Process - 7.13.2017

Billing for Zika Tests and Laboraties - 5.31.2017

You need to be Texas Medicaid enrolled to serve CHIP members - 5.31.2017

Pharmacy Notice: Mosquito Repellent Benefit for Zika Prevention (PDF 65.67 KB) - 5.16.2017 

A STAR Kids Letter: LTSS Authorizations Extended No Later than June 30, 2017 (PDF 61.32 KB) - 5.9.2017

Provider Letter Regarding Texas Health Steps Documentation (PDF 36.34 KB) - 1.24.2017

Texas Health Steps Clinical Record Review Tool (PDF 45.1 KB) - 1.24.2017

Texas Health Steps Clinical Record Review Tool with Instructions (PDF 25.97 KB) - 1.24.2017

Texas Health Steps Regional Contacts (PDF 49.06 KB) - 1.24.2017 

Prior Authorization

Outpatient Injectable Chemotherapy Prior Authorization Program Overview (PDF 72.29 KB)

UnitedHealthcare Connected Texas Medicare Medicaid
UnitedHeathcare Connected Texas Medicare Medicaid Plan Prior Authorization Requirements - Effective 1/1/2018 (PDF 250.43 KB)

UnitedHealthcare Medicare Solutions & UnitedHealthcare Community Plan
UnitedHealthcare Medicare Prior Authorization Requirements - Effective 1/1/2018 (PDF 282.37 KB)

UnitedHealthcare Community Plan - CHIP
UnitedHealthcare Community Plan Prior Authorization TX CHIP - Effective 1/1/2018 (PDF 223.3 KB)

UnitedHealthcare Community Plan - STAR
UnitedHealthcare Community Plan Prior Authorization TX STAR - Effective 1/1/2018 (PDF 225.89 KB)

UnitedHealthcare Community Plan - STAR Kids
UnitedHealthcare Community Plan Prior Authorization TX STAR Kids - Effective 1/1/2018 (PDF 232.25 KB)

UnitedHealthcare Community Plan - STAR+PLUS
UnitedHealthcare Community Plan Prior Authorization TX STAR+PLUS - Effective 1/1/2018 (PDF 230.78 KB)

UnitedHeathcare Connected (Medicare-Medicaid Plan) Prior Authorization Requirements - Effective 7/1/2017 (PDF 242.65 KB) 

UnitedHealthcare Medicare Prior Authorization Requirements - Effective 1/1/2018 (PDF 282.37 KB)

UnitedHealthcare Community Plan Prior Authorization TX CHIP - Effective 7/1/2017 (PDF 226.53 KB)

UnitedHealthcare Community Plan Prior Authorization TX STAR - Effective 7/1/2017 (PDF 225.15 KB)

UnitedHealthcare Community Plan Prior Authorization TX STAR Kids - Effective 7/1/2017 (PDF 232.22 KB)

UnitedHealthcare Community Plan Prior Authorization TX STAR+PLUS - Effective 7/1/2017 (PDF 225.95 KB)

UnitedHealthcare Medicare Prior Authorization Requirements - Effective 10/1/2017 (PDF 286.74 KB)

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 TX CHIP - Effective 4/1/2017 (PDF 219.45 KB)

UnitedHealthcare Community Plan Prior Authorization TX STAR - Effective 4/1/2017 (PDF 239.82 KB)

UnitedHealthcare Community Plan Prior Authorization TX STAR Kids - Effective 4/1/2017 (PDF 229.98 KB)

UnitedHealthcare Community Plan Prior Authorization TX STAR+PLUS - Effective 4/1/2017 (PDF 203.78 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)

Prior Authorization TX CHIP - Effective 1/1/2017 (PDF 218.73 KB)

Prior Authorization TX STAR - Effective 1/1/2017 (PDF 218.24 KB)

Prior Authorization TX STAR Kids - Effective 1/1/2017 (PDF 227.58 KB)

Prior Authorization TX STAR+PLUS - Effective 1/1/2017 (PDF 203.46 KB)

UnitedHealthcare Community Plan Prior Authorization TX STAR -Effective 10/1/2016 (PDF 218.7 KB)

UnitedHealthcare Community Plan Prior Authorization TX STAR PLUS - Effective 10/1/2016 (PDF 203.13 KB)

UnitedHealthcare Community Plan Prior Authorization TX CHIP - Effective 10/1/2016 (PDF 216.01 KB)

UnitedHealthcare Community Plan Prior Authorization TX STAR Kids - Effective 10/1/2016 (PDF 226.16 KB)

UnitedHealthcare Medicare Solutions and UnitedHealthcare Community Plan Notification / Prior Authorization Requirements -Effective 10/1/2016 (PDF 277.31 KB)

UnitedHealthcare Community Plan Prior Authorization TX STAR - Effective 7/1/2016 (PDF 196.79 KB)

UnitedHealthcare Community Plan Prior Authorization TX STAR PLUS - Effective 7/1/2016 (PDF 195.63 KB)

UnitedHealthcare Community Plan Prior Authorization TX CHIP - Effective 7/1/2016 (PDF 195.03 KB)

UnitedHealthcare Medicare Solutions and UnitedHealthcare Community Plan Notification/Prior Authorization Requirements - Effective 7/1/2016 (PDF 266.74 KB)

UnitedHealthcare Medicare Solutions and UnitedHealthcare Community Plan Notification/Prior Authorization Requirements - Effective 5/1/2016 (PDF 251.42 KB)

UnitedHealthcare Community Plan Prior Authorization TX STAR.STAR+PLUS - Effective 5/1/2016 (PDF 201.6 KB)

UnitedHealthcare Community Plan Prior Authorization TX CHIP - Effective 5/1/2016 (PDF 193.82 KB)

UnitedHealthcare Community Plan Prior AuthorizationTX CHIP - Effective 1/1/2016 (PDF 221.04 KB) Posted 1.28.2016

UnitedHealthcare Community Plan Prior AuthorizationTX STAR, STAR+PLUS - Effective 1/1/2016 (PDF 223.42 KB) Posted 1.28.2016

UnitedHealthcare Medicare Solutions Notification/Prior Authorization List - Effective 1/1/16 (PDF 250.02 KB) Posted 1.28.2016

CHIP Prior Authorization (PDF 217.91 KB) Posted 11.30.2015

STAR, STAR+PLUS Prior Authorization (PDF 236.02 KB) Posted 11.30.2015

UnitedHealthcare Medicare Solutions Notification/Prior Authorization List - Effective 1/1/16 (PDF 249.77 KB)- Posted 1.12.2016

CHIP Required Authorization (PDF 214.25 KB)Posted 7.1.2015

STAR.STAR+PLUS Prior Authorization (PDF 232.48 KB) Posted 7.1.2015

CHIP Required Authorization (PDF 203.44 KB)

STAR, STAR+PLUS Prior Authorization
(PDF 607.66 KB)

 

Mga Medikal na Injectable

Ang mga gamot sa specialty na botika na saklaw sa Medikal na Pakinabang ay maaaring ibigay sa pamamagitan ng iba't ibang channel – home infusion provider, pasilidad ng outpatient, manggagamot o specialty na botika.

Specialty pharmacy medications covered under the member’s medical benefit may be obtained through various sources ‒ home infusion providers, outpatient facilities, physicians or specialty pharmacy.

If you don’t want to buy and bill a specialty pharmacy medication covered under the member’s medical benefit, you may order it through the following network specialty pharmacy:

Specialty na Botika ng Network

Numero ng Telepono

BriovaRx

855-427-4682

The following specialty pharmacies also provide certain types of specialty medications:

Specialty na Botika ng Network

Kategorya ng Gamot

Numero ng Telepono

Accredo (nursing services)

Kakulangan sa Enzyme

Gaucher's Disease

Immune Globulin

Pulmonary Hypertension

800-803-2523

 

Option Care (nursing services)

Kakulangan sa Enzyme

Gaucher's Disease

Hemophilia

Immune Globulin

Makena

866-827-8203

Specialty na Botika ng CVS Caremark

Pulmonary Hypertension

800-237-2767


Coverage of a requested medication depends on the member’s benefit, and availability of a specific drug from a network specialty pharmacy may vary.

Upon request, a specialty pharmacy can deliver the medication to your office or another site such as a member’s home.

Medications obtained through a specialty pharmacy will be directly billed to the patient’s health plan.

 

 

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. Ang mga patakaran at alituntunin na ito ay ibinibigay para sa mga layunin ng pagbibigay-impormasyon, at hindi bumubuo ng isang payong medikal.
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

Medical Policy Update Bulletin

UnitedHealthcare Community Plan Medical Policy Update Bulletin

Integridad ng Mga Claim, Ulat, at Pagkakatawan sa Pamahalaan

Iniaatas ng UnitedHealth Group ang pagsunod sa mga batas pederal at batas ng estado na nagbabawal sa pagsusumite ng mga huwad na claim kaugnay sa mga pederal na programa ng pangangalaga sa kalusugan, kabilang na ang Medicare at Medicaid.
View our policy (PDF 38.15 KB).

Disclaimer

If UHG policies conflict with provisions of a state contract or with state or federal law, the contractual / statutory / regulatory provisions shall prevail. Upang makita ang mga na-update na pagbabago sa patakaran, piliin ang seksyon ng Bulletin sa kaliwa.

 

Site Outage

Our back up server helps ensure our site information is available to you 24/7. In the event you receive an error message, please wait a few minutes and try again, utilize UnitedHealthcare® Online or you may call Customer Service at 888-887-9003.