UnitedHealthcare Community Plan of Ohio Homepage (2024)

We know you don't have time to spare, so we put all the UnitedHealthcare Community Plan resources you need in one place. Use the navigation on the left to quickly find what you're looking for. Be sure to check back frequently for updates.

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Contact Us

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Provider Call Center

(800) 600-9007
Monday-Friday, 8 a.m. – 5 p.m.

Postal Mailing Address

UnitedHealthcare Community Plan
9200 Worthington Road, 3rd Floor
Westerville, OH 43082

Claims Mailing Address

UnitedHealthcare Community Plan
P.O. Box 8207
Kingston, NY 12402

Utilization Management Appeals Address

UnitedHealthcare Community Plan
Attn: Complaint and Appeals Department
P.O. Box 31364
Salt Lake City, UT 84131
Fax: (801) 994-1082

Claims Appeals Mailing Address

UnitedHealthcare Community Plan
Attn: Complaint and Appeals Department
P.O. Box 31364
Salt Lake City, UT 84131
Fax: (801) 994-1082

UHC Connected™ For MyCare Ohio Appeals Mailing Address

Part C Appeals or Grievances:
UnitedHealthcare Community Plan
Attn: Complaint and Appeals Department
P.O. Box 31364
Salt Lake City, UT 84131
Fax: (801) 994-1082

Medicare Part D Grievances:
UnitedHealthcare Community Plan
Attn: Complaint and Appeals Department
P.O. Box 31364
Salt Lake City, UT 84131
Fax: (801) 994-1082

Medicare Part D Appeals:
UnitedHealthcare Community Plan
Attn: Part D Standard Appeals
P.O. Box 6103
Cypress, CA 90630-9998
Fax: (877) 960-8235

Credentialing and Attestation

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For Credentialing and Attestation updates, visit the Ohio Department of Medicaid website.

Need to make a change to your provider or facility directory information?

Visit the Demographics and Profiles Section

External Medical Review (EMR)

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External medical review (EMR) is a review process conducted by an independent, external medical review entity. It is initiated by a provider who disagrees with the decision of a managed care organization (MCO) and/or the OhioRISE (Resilience through Integrated Systems and Excellence) plan to deny, limit, reduce, suspend or terminate a covered service for lack of medical necessity.

If you would like more information on EMRs, the Ohio Department of Medicaid (ODM) provides some helpful provider resources, including Frequently Asked Questions (FAQs), a Prior Authorization Denial Grid and the EMR process flow. All can be found on the ODM website.

Join Our Network

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Behavioral Health Providers

Learn how to join the Behavioral Health Network, review Community Plan Behavioral Health information, or submit demographic changes atCommunity Plan Behavioral Health.

Facility/Hospital-Based Providers, Group/Practice Providers and Individually-Contracted Clinicians

The state-specific requirements and process on how to join the UnitedHealthcare Community Plan networkis found in the UnitedHealthcare Community Plan Care Provider Manuals.

Learn about requirements forjoining our network.

Medicaid Managed Care Rule

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Overview

The Centers for Medicare & Medicaid Services (CMS) established the Medicaid Managed Care Rule to:

  • Promote quality of care
  • Strengthen efforts to reform the delivery of care to individuals covered under Medicaid and Children’s Health Insurance Plans (CHIP)
  • Strengthen program integrity by improving accountability and transparency

Enhance policies related to program integrity With the Medicaid Managed Care Rule, CMS updated the type of information managed care organizations are required to include in their care provider directories.

Member Information: Current Medical Plans, ID Cards, Provider Directories, Dental & Vision Plans

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Visit UHCCommunityPlan.com/OHfor current member plan information including sample member ID cards, provider directories, dental plans, vision plans and more.

Plan information is available for:

  • UnitedHealthcare Community Plan of Ohio
  • UnitedHealthcare Connected® for MyCare Ohio
  • UnitedHealthcare Dual Complete (HMO SNP)
  • UnitedHealthcare Dual Complete (HMO-POS SNP)

Member plan and benefit information can also be found atUHCCommunityPlan.com/OHandmyuhc.com/communityplan.

Search for a Care Provider

Search for a Dentist

Need to make a change to your provider or facility directory information?

Visit the Demographics and Profiles Section

PCP Membership Reports

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CommunityCare

The best way for primary care providers (PCPs) to view and export thefull member roster is using the CommunityCare feature on the UnitedHealthcare Provider Portal, which allows you to:

  • Identify Medicaid recipients who need to have their Medicaid recertification completed and approved by the state in order to remain eligible to receive Medicaid benefits
  • See a complete list of all members, or just members added in the last 30 days
  • Export the roster to Microsoft Excel
  • View most Medicaid and MedicareSpecial Needs Plans (SNP) members’ plans of care and health assessments
  • Enter plan notes and view notes history (for some plans)
  • Obtain HEDIS information for your member population
  • Access information about members admitted to or discharged from an inpatient facility
  • Access information about members seen in an emergency department

For help using CommunityCare feature on the UnitedHealthcare Provider Portal, please see ourQuick Reference Guide.If you’re not familiar with UnitedHealthcare Provider Portal, visit our Portal Resources page.

CommunityCare Overview

Provider Contracts

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The Ohio provider contract with United HealthCare Community Plan is listed below.

Reporting Health Care Fraud, Waste and Abuse

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Reporting Fraud, Waste or Abuse to Us

When you report a situation that could be considered fraud, you’re doing your part to help save money for the health care system and prevent personal loss for others.Ifyou suspect another provider or member has committed fraud, waste or abuse, you have a responsibility and a right to report it.

Taking action and making a report is an important first step.After your report is made, we will work to detect, correct and prevent fraud, waste, and abuse in the health care system.

Call us at1-844-359-7736or visituhc.com/fraud to report any issues or concerns.

Health Insurance Portability and Accountability Act (HIPAA) Information

HIPAA standardized both medical and non-medical codes across the health care industry and under this federal regulation, local medical service codes must now be replaced with the appropriate Healthcare Common Procedure Coding System (HCPCS) and CPT-4 codes.

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.

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.

UnitedHealthcare Community Plan of Ohio Homepage (2024)

FAQs

Is the United Healthcare Community Plan of Ohio a Medicaid plan? ›

UnitedHealthcare Community Plan of Ohio

Our Ohio Medicaid plan covers eligible families, pregnant women of any age, infants, children and young adults. The plan also offers extra support and care to adults and children with a disability, long-term illness or special health care needs.

What is the best Medicaid health plan in Ohio? ›

Buckeye Health Plan Rated Best Medicaid Health Plan for Quality Performance. The Ohio Department of Medicaid (ODM) awarded Buckeye Health Plan the highest quality rating among all Ohio managed care plans with 20 stars across the five categories on its 2018 Managed Care Plans Report Card published today.

Can I check my Ohio Medicaid status online? ›

How can I check on the status of my application? Call our Consumer Hotline at 800-324-8680 or log in to your Ohio Benefits account here to check the status of your application.

Does Ohio Medicaid have OTC benefits? ›

The Ohio Department of Medicaid (ODM) provides coverage of both prescription and over-the-counter drugs. The links below allow both providers and members to find information about drug coverage.

Who qualifies for the UCard from UnitedHealthcare? ›

If you qualify for both Medicare and Medicaid, you may be able to get a dual health plan from UnitedHealthcare. Dual health plans typically include many extra benefits to help simplify life for full dual-eligible members. You'll also get UCard to help make it easier to take advantage of those extra benefits.

Why did UnitedHealthcare send me a check? ›

UnitedHealthcare intends to include its self-funded (ASO) plans in the virtual card payment program. ASO customers can elect to opt out of participation in the program. In those circumstances, you may receive a paper check for claims for members of ASO plans that have opted out.

What is the monthly income limit for Medicaid in Ohio in 2024? ›

Family Size Monthly Income* 1 $1,883 2 $2,555 3 $3,228 4 $3,900 5 $4,573 6 $5,245 7 $5,918 8 $6,590 9 $7,263 10 $7,935 Families with monthly incomes higher than the amount in the first column, but lower than the amount in the second column MUST apply if they do not have private health insurance.

Does Medicaid pay for prescriptions in Ohio? ›

Medicaid will only pay for certain prescriptions the Medicare Part D does not cover. Be sure to give both your Medicare Part D and your Medicaid card to your pharmacist. Also, you will automatically qualify for "extra help" so you will not be charged a deductible or monthly premiums.

How often do you have to renew Ohio Medicaid? ›

Your Medicaid benefits will need to be renewed annually and you will be notified when it is time to renew. Click here for more information about the renewal process.

Can you have Medicaid and private insurance in Ohio? ›

You can have Medicaid and private health insurance at the same time, and there are some advantages and disadvantages to doing so. In many cases, if you're eligible for both Medicaid and private insurance, your private insurance plan will be the primary coverage, and your Medicaid coverage will be supplemental.

How long does it take to get Medicaid approved in Ohio? ›

Average Approval Times for Medicaid Applications. States are required by federal law to approve or deny Medicaid applications within 45 days, or 90 days for applications that require a disability determination.

Does Ohio Medicaid pay for weight loss drugs? ›

Drugs that fall into one of the following categories are non-covered by the Ohio medicaid pharmacy program: (1) Drugs for the treatment of obesity. (2) Drugs for the treatment of infertility. (3) Drugs for the treatment of erectile dysfunction.

Is UnitedHealthcare of Ohio Medicaid? ›

UnitedHealthcare is proud to offer health care coverage to more than 380,000 Ohioans through Medicaid.

What food items can you get with a OTC card? ›

Examples of approved food items are fruits, vegetables, meats, poultry, seafood, eggs, dairy, rice, pasta, beans, and much more.

How many Medicaid plans are there in Ohio? ›

Ohio Medicaid delivers health care coverage to more than 3 million Ohio residents. Of those, more than 90% receive coverage through one of our seven managed care plans.

Is UHC a health plan? ›

UnitedHealthcare Connected® for One Care (Medicare-Medicaid plan) is a health plan that contracts with both Medicare and MassHealth (Medicaid) to provide benefits of both programs to enrollees.

Who qualifies for CareSource in Ohio? ›

Eligibility. Those who are eligible for Medicare Parts A & B and Medicaid who live in our service area may join CareSource® MyCare Ohio. To enroll, call the Ohio Medicaid Consumer Hotline at 1-800-324-8680 (TTY: 1-800-292-3572), or visit www.ohiomh.com and select MyCare Ohio.

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