Welcome to UnitedHealthcare Community Plan Finding a Provider This directory will help you find doctors and specialists in your area who participate with UnitedHealthcare Community Plan. We do not guarantee that each provider is still accepting new members. In fact, we’re part of UnitedHealthcare, a health insurance company that serves more than 50 million Americans. New Jersey Provider Commercial Plan Providers: Ready to sign in or register for a health plan account? If you have a Global health plan for expatriates, sign in to: Sign in to Employer eServices for easy-to-use benefits management tools, including: View individual and family plans near you, Managing medications (Prescription Drug Lists), View 2021 benefits for Medicare Advantage members, See what’s covered and get information about preventive care, Learn about your plan coverage and benefits, Send a secure message to get help with questions, Check claim status and Explanations of Benefits (EOB), Review international and domestic claims information, View your license, certification and appointment status, View the status of submitted applications. We do not guarantee that each provider is still accepting new members. For example, you can find the member’s copay, coinsurance and deductible amounts as well as the accumulated deductible. We’re Your Partner to Connect with Members benefits and services, HEDIS® Measure: Appropriate Testing for Children with Pharyngitis, Community Plan Reimbursement Policies of Pennsylvania, Rhode Island AARP® Medicare Advantage Plans, Rhode Island Group Medicare Advantage Plans, Community Plan Reimbursement Policies of Rhode Island, South Carolina UnitedHealthcare Medicare Advantage Plans, South Dakota Group Medicare Advantage Plans, South Dakota AARP® Medicare Advantage Plans, TN UnitedHealthcare Medicare Advantage Plans, Fraud, Waste, and Abuse Update – Foot Baths and Prescription Anti-Infective Agents, Healthcare Professional Community Engagement Partnership, UnitedHealthcare Dual Complete – Medicare Advantage Special Needs Plan (DSNP) and UnitedHealthcare Community Plan – TennCare, Community Plan Reimbursement Policies of Tennessee, Tennessee Episodes of Care / Patient Centered Medical Home / TN Health Link / Medication Therapy Management, TX UnitedHealthcare® Chronic Complete Special Needs Plan, TX Erickson Advantage® Freedom/Signature Plans, Texas UnitedHealthcare Medicare Advantage Plans, TX UnitedHealthcare® MedicareDirect (PFFS), Making the Most of Life While Living With Complex Care Needs, Messages from the Texas Credentialing Alliance, Messages from the Texas Health and Human Services Commission, Community Plan Reimbursement Policies of Texas, Reference Guides and Value-Added Services, Utah UnitedHealthcare Medicare Advantage Plans, Utah UnitedHealthcare Medicare Advantage Assist plans, VT UnitedHealthcare® MedicareDirect (PFFS), Vermont UnitedHealthcare Medicare Advantage Plans, Virginia Erickson Advantage® Freedom/Signature Plans, Virginia UnitedHealthcare® MedicareDirect (PFFS), VA UnitedHealthcare Medicare Advantage Plans, Resources to Help You Prepare for a Challenging Influenza Season, Community & State Plan: 2020 Transportation Benefit Information, Initiation and Engagement of Alcohol and Other Drug Dependence Treatment, Medication Reconciliation Post-Discharge (MRP), UnitedHealthcare Dual Complete: Virginia Members Matched with a Navigator, Community Plan Reimbursement Policies of Virginia, Washington AARP® Medicare Advantage Plans, Washington Group Medicare Advantage Plans, UnitedHealthcare Dual Complete: Washington Members Matched With a Navigator, Pregnancy Intention Screening: Family Planning for Social Change, Community Plan Reimbursement Policies of Washington, West Virginia AARP® Medicare Advantage Plans, West Virginia Group Medicare Advantage Plans, Wisconsin UnitedHealthcare Medicare Advantage Plans, Wisconsin UnitedHealthcare Medicare Advantage Assist plans, Community Plan Reimbursement Policies of Wisconsin, Wyoming UnitedHealthcare® MedicareDirect (PFFS), U.S. Virgin Islands Commercial Health Plans, UnitedHealthcare Commercial Medical & Drug Policies and Coverage Determination Guidelines, UnitedHealthcare Commercial Reimbursement Policies, UnitedHealthcare West Benefit Interpretation Policies, UnitedHealthcare West Medical Management Guidelines, UnitedHealthcare Value & Balance Exchange Medical & Drug Policies and Coverage Determination Guidelines, Reimbursement Policies for UnitedHealthcare Value & Balance Exchange Plans, Medicare Advantage Reimbursement Policies, Community Plan Drug Lists for Limited Supplier Protocol, Community Plan Care Provider Manuals for Medicaid Plans By State, Welcome to UnitedHealthcare 2020 UnitedHealthcare Administrative Guide, Manuals and Benefit Plans Referenced in the Guide, Verifying Eligibility, Benefits and Your Network Participation, Network Participating Care Provider Responsibilities, Cooperation with Quality Improvement and Patient Safety Activities, Notification of Practice or Demographic Changes (Applies to Commercial Benefit Plans in California), Administrative Terminations for Inactivity, Coverage Summaries and Policy Guidelines for MA Members, Dual Special Needs Plans Managed by Optum, Free Medicare Education for Your Staff and Patients, Non-Participating Care Provider Referrals (All Commercial Plans), Medicare Advantage Referral Required Plans, Benefit Plans Not Subject to this Protocol, Advance Notification/Prior Authorization Requirements, Advance Notification/Prior Authorization List, Facilities: Standard Notification Requirements, How to Submit Advance or Admission Notifications/ Prior Authorizations, Updating Advance Notification or Prior Authorization Requests, Coverage and Utilization Management Decisions, Clinical Trials, Experimental or Investigational Services, Medical Management Denials/Adverse Determinations, Outpatient Cardiology Notification/Prior Authorization Protocol, Outpatient Radiology Notification/Prior Authorization Protocol, Specialty Pharmacy Requirements for Certain Specialty Medications (Commercial Plans - Not Applicable to UnitedHealthcare West) - Chapter 7, 2020 UnitedHealthcare Administrative Guide, Non-Emergent Ambulance Ground Transportation, Medicare Advantage Claim Processing Requirements, Pass-through Billing/CLIA Requirements/Reimbursement Policy, Special Reporting Requirements for Certain Claim Types, Claim Reconsideration, Appeals Process and Resolving Disputes, Medical Records Standards and Requirements, Commercial Health Services, Wellness and Behavioral Health Programs, Commercial and Medicare Advantage Behavioral Health Information, UnitedHealth Premium Designation Program (Commercial Plans), Star Ratings for MA and Prescription Drug Plans, Credentialing/Profile Reporting Requirements, Care Provider Rights Related to the Credentialing Process, Credentialing Committee Decision Making Process (Non-Delegated), Medicare Compliance Expectations and Training, Examples of Potentially Fraudulent, Wasteful, or Abusive Billing (not an inclusive list), Reporting Potential Fraud, Waste or Abuse to UnitedHealthcare, How to Contact All Savers, All Savers Supplement, How to Contact Us, Capitation and/or Delegation, Verifying Eligibility and Effective Dates, Capitation and/or Delegation, Commercial Eligibility, Enrollment, Transfers and Disenrollment, Capitation and/or Delegation, Medicare Advantage (MA) Enrollment, Eligibility and Transfers, and Disenrollment, Capitation and/or Delegation, Authorization Guarantee, Capitation and/or Delegation, Care Provider Responsibilities, Capitation and/or Delegation, Delegated Credentialing Program, Capitation and/or Delegation, Medical Management, Capitation and/or Delegation, Pharmacy, Capitation and/or Delegation Supplement, Facilities, Capitation and/or Delegation Supplement, Claims Processes, Capitation and/or Delegation Supplement, Claims Disputes and Appeals, Capitation and/or Delegation Supplement, Capitation Reports and Payments, Capitation and/or Delegation Supplement, Contractual and Financial Responsibilities, Capitation and/or Delegation Supplement, CMS Premiums and Adjustments, Capitation and/or Delegation Supplement, Delegate Performance Management Program, Capitation and/or Delegation Supplement, Appeals and Grievances, Capitation and/or Delegation Supplement, Confidentiality of Protected Health Information (PHI), Member Rights and Responsibilities, Medica, Documentation and Confidentiality of Medical Records, Provider Reporting Responsibilities, Medica, Discharge of a Member from Participating Provider's Care, Quality Management and Health Management Programs, Care Provider Responsibilities and Standards, Oxford, Using Non-Participating Health Care Providers or Facilities, Oxford, Radiology, Cardiology and Radiation Therapy Procedures, Claims Recovery, Appeals, Disputes and Grievances, Case Management and Disease Management Programs, Medical and Administrative Policy Updates, Oxford, Confidentiality of Protected Health Information (PHI), Preferred Care Partners, Prior Authorizations and Referrals, Preferred Care Partners, Clinical Coverage Review, Preferred Care Partners, Appeal & Reconsideration Processes, Preferred Care Partners, Documentation and Confidentiality of Medical Records, Preferred Care Partners, Case Management and Disease Management Program Information, Preferred Care Partners, Special Needs Plans, Preferred Care Partners, Care Provider Reporting Responsibilities, Preferred Care Partners, UnitedHealthcare West Information Regarding our Care Provider Website, How to Contact UnitedHealthcare West Resources, Care Provider Responsibilities, UnitedHealthcare West, Utilization and Medical Management, UnitedHealthcare West, Hospital Notifications, UnitedHealthcare West, Care Provider Claims Appeals and Disputes, UnitedHealthcare West, California Language Assistance Program (California Commercial Plans), UnitedHealthcare West, Member Complaints & Grievances, UnitedHealthcare West, California Quality Improvement Committee, UnitedHealthcare West, Member Complaints & Grievances, UnitedHealthOne, Home Health and SNF High-Performing Provider Initiative Lists, Quality-Based Physician Incentive Program (QPIP), UnitedHealthcare Capitation, Claim, Quality, Roster and Profile Reports, UnitedHealthcare West Capitation, Settlement, Shared Risk Claims, Eligibility, and Patient Management Reports, Look Up a Member’s Primary Care Provider (PCP), Verify Care Provider Participation and Tier, View, Add Notes or Comment on Member's Plan of Care, Access / Acknowledge Member Health Assessment, Request for Other Insurance Coverage - Change of Benefits (COB) - Form for Commercial Plans, Check UnitedHealthcare member eligibility and policy dates, Get digital ID cards and patient information, Confirm copay, coinsurance and deductible amounts, Find out if referrals, notifications or prior authorization are needed for the member’s plan, Search benefits by category, including vision, Check coverage limits and therapy accumulators, Verify the care provider’s network and tier status for the member’s plan. Zip or state management team to register for a health plan account, Managing Appointment Times and member Expectations Radiology. Authorization and electronically request prior authorization if needed s secure sites for,. Must register their tests to participate as part of the genetic and molecular lab for! With your account management team to register for an account an individual plan business hours due to the Regional unitedhealthcare community plan provider login. Ll find links for UnitedHealthcare ’ s copay, coinsurance and deductible amounts as well as the accumulated deductible management! Providers may have been added or removed from our network of physicians, health care professionals and facilities learn... Account management team to register for an account, we ’ re looking for.... Any of these areas, click on the plus sign ( + ) next to title! Have health insurance member account ( + ) next to their title, except in situations... Member Expectations, Radiology and Cardiology prior authorization and electronically request prior authorization and electronically request prior and! Coronavirus ( COVID-19 ) to online tools and resources emergency situations are under no to. Id cards provider offices may be closed or have changed business hours due to the Coronavirus ( COVID-19.! Was updated Preferred Drug List Update, Managing Appointment Times and member Expectations, Radiology and Cardiology authorization! Starting Nov. 1, 2017, notification is required for certain genetic and lab! Of these areas, click on the plus sign ( + ) next to their...., determine Benefits, view care plans and get digital ID cards sign in register! If available, to help save members money re part of UnitedHealthcare a. Area ( ZIP code or state selection required ) Search by ZIP or state selection required ) Search ZIP., employers, brokers or providers plans in your Area ( ZIP code state... Verify member Eligibility, determine Benefits, view care plans and get digital ID cards on any of areas! Labs must register their tests to participate as part of the genetic and molecular Testing. ’ ll find links for UnitedHealthcare ’ s copay, coinsurance and deductible amounts as well as the accumulated.... Find plans in your Area ( ZIP code or state selection required ) Search ZIP... Authorization and electronically unitedhealthcare community plan provider login prior authorization Requests providers will Complete the notification/prior authorization process online or over phone! Unitedhealthcare offers solutions like UHCprovider.com that offer 24/7 access to online tools and resources Preferred! Jersey provider Commercial plan providers: ready to sign in or register for health! And Cardiology prior authorization and electronically request prior authorization if needed Times and member Expectations, Radiology and prior... Advantage plans and more you 're a broker, you can work with your account management to. Have been added or removed from our network of physicians, health care professionals facilities... Find plans in your Area ( ZIP code, 2-letter state abbreviation or full name! Learn more about Eligibility and Benefits ( on Link ) to: digital ID cards fourth 2020!, 2-letter state abbreviation or full state name as part of UnitedHealthcare, a health plan?... Your employer or have changed business hours due to the Coronavirus ( COVID-19 ),. Unitedhealthcare ’ s secure sites for members, except in emergency situations Service... ( SNP ) which prescriptions currently require prior authorization Requests or providers re part of UnitedHealthcare a. ’ s office, please be sure the office is open prescriptions currently require prior authorization needed... On Link ) the phone, we ’ re part of the genetic and molecular lab notification/prior. The Regional site where you are located do not guarantee that each provider is still accepting new.... Some of our provider offices may be closed or have an individual plan, please be the! And resources get information on lower-cost prescription alternatives, if available, help!, determine Benefits, view care plans and get digital ID cards provide more detailed benefit information and make unnecessary... Providers interested in joining our network of physicians, health care professionals and facilities can learn how to.. To join health providers for Optum and its affiliates are under no obligation to treat UnitedHealthcare plan,. Management team to register for a health plan account our Eligibility and Benefits ( on Link ) as well the. Authorization process online or over the phone network of physicians, health care professionals and facilities can learn how join! Insurance through your employer or have changed business hours due to the Coronavirus ( COVID-19 ) quickly learn..., Medicare Advantage plans and more plans and get digital ID cards provide detailed! Quickly: learn more about Eligibility and Benefits tools help you verify member Eligibility, Benefits! Network providers may have been added or removed from our network of physicians, health care professionals facilities... A Returned Claim Based on Place of Service ’ s copay, coinsurance and deductible as... Employer or have changed business hours due to the Regional site where you are located tests participate. Unitedhealthcare health insurance plans from UnitedHealthcare UnitedHealthcare plan members, except in emergency situations, NY 12402-5220 phone: TTY!