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.
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Contact Us
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Provider Service Center
888-362-3368, available Monday – Friday from 8:00 a.m. – 6:00 p.m.
Claims Address
Medicaid and NJ Familycare
UnitedHealthcare Community Plan
P.O. Box 5250
Kingston, NY 12402-5250
Payer ID: 86047
UnitedHealthcare Dual Complete ONE
UnitedHealthcare Dual Complete® ONE
P.O. Box 5250
Kingston, NY 12402-5250
Payer ID: 86047
Claims Appeal Address
PartCAppeals and Grievance Department
UnitedHealthcare Community Plan
Attn: Complaint and Appeals Department
P.O. Box 31364
Salt Lake City, UT 84131-0364
Part D Appeals and Grievance Department
Attn: CA124-0197
P.O. Box 6106
Cypress, CA 90630-9948
UM Appeals
Medicaid and NJ Familycare
UnitedHealthcare Community Plan
Attn: UM Appeals Coordinator
P.O. Box 31364
Salt Lake City, UT 84131
UnitedHealthcare Dual Special Needs (HMO SNP)
UnitedHealthcare Dual Complete One
Attn: UM Appeals Coordinator
P.O. Box 31364
Salt Lake City, UT 84131
Credentialing and Attestation
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All Providers
For Credentialing and Attestation updates, contact the National Credentialing Center at 1-877-842-3210.
Credentialing and Recredentialing forManaged Long-Term Care Services and Supports (MLTSS) Providers
All documentation, inquires, and communication related to MLTSS credentialing and recredentialing information can be emailed to us atNJ_MLTSS_CRED@uhc.com.
- If you are a participating MLTSS provider, you need to send us your recredentialing documents each year to ensure we have your most current complete required documentation.
- All forms and documents can be emailed toNJ_MLTSS_CRED@uhc.com. Include the name of the facility and the words “Recredentialing Application” in the subject line.
- Documents can also be mailed to:
- UnitedHealthcare Community Plan
Attn: MLTSS Credentialing
283-289 Market Street 12th Floor, Suite 1202
Newark, NJ 07102
- UnitedHealthcare Community Plan
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.
Managed Long-Term Care Services and Supports (MLTSS) Providers
If you are interested in becoming a participating MLTSS provider, please emailNJ_MLTSS_CRED@UHC.comfor more information or to request a credentialing application. Include the name of the facility and the words “Credentialing Application” in the subject line.
Member Information: Current Medical Plans, ID Cards, Provider Directories, Dental & Vision Plans
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Visit UHCCommunityPlan.com/NJfor current member plan information including sample member ID cards, provider directories, dental plans, vision plans and more.
Plan information is available for:
- New Jersey FamilyCare
- New Jersey Managed Long Term Services and Supports (MLTSS) Pharmacy Program
Member plan and benefit information can also be found atUHCCommunityPlan.com/NJandmyuhc.com/communityplan.
Care Provider Search
Search for a care provider by plan name:
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.
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
Reporting Health Care Fraud, Waste and Abuse
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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.
If any provider or person discovers fraud and/or abuse occurring in any State or federally-funded health benefit program, they should report it to theOffice of State Comptroller, New Jersey Medicaid Fraud Division hotline at 1-888-937-2835 or website athttp://nj.gov/comptroller/divisions/medicaid.
Other resources
UnitedHealthcare Dual Complete Special Needs Plans (SNP)
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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.
Learn more about the Dual Special Needs Program
