UnitedHealthcare Community Plan of North Carolina
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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Resources
Provider Services contacts
Please call 800-638-3302, 8 a.m.–6 p.m. ET, Monday–Saturday
North Carolina provider contracting
Email: so_atlantic_phys_contracting@uhc.com
Mailing address
UnitedHealthcare Community Plan of North Carolina
3803 N. Elm Street
Greensboro, NC 27455
Behavioral health crisis
Optum Behavioral Health: Call 877-614-0484 or email optum.nc.pr@optum.com
Optum Behavioral Health Providers: Email management@optum.com
NC provider relations: Email optum.nc.pr@optum.com
Pharmacy service line
Phone: 855-258-1593 (OptumRx)
Online: professionals.optumrx.com
MARCH Vision Care
Phone: 866-376-6780 or 844-736-2724
UnitedHealthcare Community Plan of North Carolina health care professional enrollment and credentialing is completed through NCTracks. NCTracks is the multi-payer Medicaid Management Information System for the North Carolina Department of Health and Human Services (NCDHHS).
The NCDHHS fiscal agent enrollment team, CSRA, verifies all your information, ensuring that you meet credentialing requirements and you’re in good standing. Once your participation in the program has been approved, you’ll be notified by email and can then begin submitting member claims.
For questions and application information, visit the NCTracks website.
For questions about credentialing and attestation updates, connect with us through chat 24/7 in the UnitedHealthcare Provider Portal. For additional contact information, visit our Contact us page.
To contract with the Community Plan of North Carolina – Medicaid, please contact the NC Health Plan Provider Call Center at 800-638-3302.
Behavioral Health Providers
Learn how to join the behavioral health network, review Community Plan behavioral health information, or submit demographic changes at Community Plan Behavioral Health. You may also contact Optum Behavioral Health at 877-614-0484.
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 network is found in the UnitedHealthcare Community Plan Care Provider Manuals.
Learn about requirements for joining our network.
The known issues log is a current list of open and closed known global claims issues. For questions related to open issues, reach out to your provider advocate or call Provider Services at 800-638-3302.
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.
Visit UHCcommunityplan.com/nc for current member plan information including sample member ID cards, provider directories, dental plans, vision plans and more.
Plan information is available for:
- Dual Complete (RPPO SNP) Program
- Medicaid
Member plan and benefit information can also be found at UHCcommunityplan.com/nc and myuhc.com/communityplan.
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 844-359-7736 or visit uhc.com/fraud to report any issues or concerns.
As a fraud, waste and abuse detection tool, UnitedHealthcare uses the Recipient Explanation of Medical Benefits (REOMB) process to verify services were provided to members as billed. With this process, an explanation of benefits statement is sent to a random number of members. If you suspect fraud, waste or abuse within the NC Managed Care Program as it relates to a UnitedHealthcare member or services provided, please call 800-638-3302.
Per North Carolina DHHS Special Bulletin COVID-19 #168: Vaccination Counseling Code Reimbursement, effective 6/22/21 providers must bill CPT 99401 with a CR modifier and there is no requirement for a specific diagnosis code.
Targeted case management and care management duplication statement
UnitedHealthcare is committed to the health and well-being of all our members and in doing so offers care management support for members needing support managing chronic conditions, linking to social supports and/or otherwise needing support accessing certain benefits. Certain members fall within certain priority populations (e.g., members with HIV) and receive care management outreach either through UnitedHealthcare staff or staff within delegated care management entities such as Tier 3 advanced medical homes, clinical integrated networks or local health departments. In review of the HIV targeted case management service description and clinical coverage policy, it was determined that the service closely mirrors the care management requirements established by the North Carolina Department of Health Benefits for members enrolled in the standard plans and providing both required care management supports as well as HIV targeted case management would be duplicative and cause unnecessary member confusion and abrasion. As such, the case management services and supports available through UnitedHealthcare and the delegated case management entities will be the mechanism available to members with HIV/AIDS rather than the separate service of HIV targeted case management.
Program Overview
The Early Periodic Screening, Diagnosis and Treatment (EPSDT) program combines screening, diagnostic and treatment services to Medicaid-eligible individuals from birth to age 21. These services give children early access to preventive and comprehensive health care to help prevent disease and/or detect disabilities in their early stages, when they are more effectively treated.
References
AAP Bright Futures Recommendations and content of complete encounters for periodic screening
EPSDT overview
- UnitedHealthcare Care Provider Manual (Chapter 5, Pages 57 - 61 only)
- North Carolina DHHS EPSDT
- North Carolina DHHS Medicaid Benefit for Children and Adolescents Under Age 21
Medical necessity requirements of federal EPSDR law, including details of meeting EPSDT criteria when submitting prior approval requests
- The Pediatric Medical Necessity Review and EPSDT Guarantee
- Listing of EPSDT Services found at 42 U.S.C. § 1396d(a) [1905(a) of the Social Security Act
- EPSDT Policy Instructions
Dental education and outreach
- North Carolina DHHS Into the Mouths of Babes
- North Carolina Division of Medical Assistance Oral Health Periodicity Schedule
- North Carolina Medicaid Dental Services
Behavioral Health screenings
- UnitedHealthcare Care Provider Manual (Chapter 7, Pages 65 - 67 only)
- Optum - Behavioral Health Toolkit for Medical Providers
- Bright Futures Implementation Tip Sheet - Promoting Mental Health
Developmental screenings
Early intervention, care coordination and other state and community services
- North Carolina Early Childhood Action Plan (Pages 15 - 17 Preventive Health Services)
- Provider Playbook 2019 North Carolina Medicaid - Early Intervention Services in Medicaid Managed Care
- North Carolina DHHS Early Intervention
UnitedHealthcare Dual Complete® Special Needs Plan
UnitedHealthcare Dual Complete Special Needs Plans (D-SNP) offer benefits for people with both Medicare and Medicaid. These D-SNP plans provide benefits beyond Original Medicare and may include transportation to medical appointments and vision exams. Members must have Medicaid to enroll.
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 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 UnitedHealth Group 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 Policies and Clinical Guidelines section at left.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
CPT® is a registered trademark of the American Medical Association.