Providing eye care for the greater Seattle area (downtown Seattle, SODO, Tukwila, White Center, Capital Hill, Belltown, Northgate, Shoreline, Burien, West Seattle, Rainier Beach, Fremont, Queen Anne, Ballard, Bellevue, Mercer Island, Kirkland, Issaquah, Renton, Seatac), since 2015; including eye exams for glasses, sunglasses, contact lens exams, and office visits by our optometrists.
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.
Prior Authorization and Notification Resources
Current Policies and Clinical Guidelines
Provider Administrative Manual and Guides
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Visit UHCCommunityPlan.com/MI for current member plan information including sample member ID cards, provider directories, dental plans, vision plans and more.
Plan information is available for:
- Healthy Michigan
- UnitedHealthcare Community Plan of Michigan
Member plan and benefit information can also be found at UHCCommunityPlan.com/MI and myuhc.com/communityplan.
For Credentialing and Attestation updates, contact the National Credentialing
Center at 1-877-842-3210.
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.
The best way for primary care providers (PCPs) to view and export the full member roster is using the CommunityCare tool, which allows you to:
- See a complete list of all members, or just members added in the last 30 days
- Export the roster to Excel
- View most Medicaid and Medicare 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, please see our Quick Reference Guide. If you’re not familiar with, go to UHCprovider.com/portal.
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. If you 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 at 1-844-359-7736 or visit uhc.com/fraud to report any issues or concerns.
UnitedHealthcare Dual Complete® Special Needs Plan
UnitedHealthcare Dual Complete Special Needs Plans (SNP) offer benefits for people with both Medicare and Medicaid. These SNP plans provide benefits beyond Original Medicare, and may include transportation to medical appointments and vision exams. Members must have Medicaid to enroll.
Current News, Bulletins and Alerts
Last Modified | 09.16.2022
UnitedHealthcare Community Plan and MDHHS recommend the use of layered COVID-19 mitigation strategies for individuals.
Learn More
Last Modified | 05.18.2022
The Michigan Department of Health and Human Services (MDHHS) launched the We Treat Hep C Initiative to help eliminate the hepatitis C virus (HCV) in Michigan. The We Treat Hep C initiative has removed barriers to care and offers support to health care professionals testing and treating UnitedHealthcare Community Plan members for hepatitis C.
Learn More
Last Modified | 04.29.2022
Effective Aug. 1, 2022, Optum will manage prior authorization requests for non-oncology injectable medications that are covered on the medical benefit for UnitedHealthcare Community Plans.
Learn More
Last Modified | 08.12.2021
To help you treat patients with sickle cell disease, UnitedHealthcare Community Plan of Michigan has training, care managers and support resources.
Learn More
Last Modified | 07.09.2021
UnitedHealthcare Community Plan network providers will have the opportunity to share their feedback about their experience working with us by taking our Physician Satisfaction Survey. This survey applies to physicians who participate in Medicaid.
Learn More
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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. View our policy.
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.