Provider manual
01.01.2025 - An updated Hawaii Care Provider Manual is now available.
Hawaii: Registration requirement for Medicaid providers
The Hawaii Department of Human Services (DHS)/Med-QUEST Division (MQD) requires all care providers who serve QUEST members to register with the new MQD provider enrollment system, HOKU, by December 31, 2023. Learn more.
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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Monday - Friday, from 7:45 a.m. - 4:30 p.m. Hawaiian Standard Time (HST)
1132 Bishop Street., Suite 400
Honolulu, HI 96813
Phone: 1-808-535-1000
UnitedHealthcare Community Plan QUEST Integration
P.O. Box 31365
Salt Lake City, UT 84131-0365
Payer ID#: 87726 (EDI Claims Submission)
For ERA, use Payer ID# 04567
Fax: 1-877-840-5581
Website: www.providerexpress.com
Optum
P.O. Box 30757
Salt Lake City, UT 84130-0757
Payer ID#: 87726 (EDI Claims Submission)
For ERA, use Payer ID# 04567
Prior Authorization Phone: 1-800-310-6826
Prior Authorization Fax: 1-866-940-7328
Help Desk Phone: 1-800-797-9791
Bioscrip-Specialty Drug Phone: 1-800-584-0265
Formulary Information: uhccommunityplan.com/hi.html
Reservations: 1-866-475-5744
Ride Assistance: 1-866-475-5745
TTY (Heaing Impaired): 1-866-288-3133
UnitedHealthcare is her to help your practice successfully transition to the integrated care clinical model.
If you have any questions, please contact the community integration team at hicollaborativecare@uhc.com.
For more training and educational resources, please click here.
Thank you for your interest in becoming a network care provider with UnitedHealthcare Community Plan of Hawaii. In joining our network, you’ll become part of a group of physicians, health care professionals and facilities who share our commitment to helping people live healthier lives and making the health care system better for everyone.
To join our network:
1. Submit your credentialing application
Credentialing is required for all licensed independent practitioners and facilities to participate in the UnitedHealthcare network. We partner with MDX and Optum to help manage the credentialing process. Please follow these steps to submit your credentialing application based on your practicing specialty. These are also the resources to call if you have a question or want to check the status of your application.
2. Complete your participation agreement
After credentialing is complete, UnitedHealthcare Community Plan will send you a Participation Agreement (contract) through a secure application called DocuSign. (If we don’t have a valid email address for you, we’ll mail you the Participation Agreement.) Once contracting is completed, you’ll receive the countersigned agreement with your effective date.
3. Get connected with us electronically
Once you are credentialed and have received your countersigned agreement, your next step is to know how to get connected with us electronically so you can take advantage of our online tools, paperless options, electronic payments and more. Review our Quick Start Guide for the most recent checklist.
We’re here to help! If you have questions, please call us at 888-980-8728 from 7:45 a.m. to 4:30 p.m. Hawaii Time, Monday through Friday.
The Centers for Medicare & Medicaid Services (CMS) established the Medicaid Managed Care Rule to:
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/HI for current member plan information including sample member ID cards, provider directories, member handbooks, dental plans, vision plans and more.
Plan information is available for:
Member plan and benefit information can also be found at UHCCommunityPlan.com/HI and myuhc.com/CommunityPlan.
Guides:
The best way for primary care providers (PCPs) to view and export the full member roster is using the CommunityCare feature on the UnitedHealthcare Provider Portal, which allows you to:
For help using CommunityCare feature in the UnitedHealthcare Provider Portal, please see our user guide. If you’re not familiar with UnitedHealthcare Provider Portal, visit our portal resources page.
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.
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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.
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.
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.
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.