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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The Centers for Medicare and Medicaid Services (CMS) federal regulations, including the Affordable Care Act and the 21st Century Cures Act, require providers who file claims with Louisiana Medicaid to enroll in Medicaid's web-based Provider Enrollment Portal.
In October 2024, Louisiana Medicaid launched its Provider Enrollment Rebaseline effort, which facilitates Medicaid enrollment for newly credentialed managed care organization (MCO) providers. Enrollment with the state Medicaid agency is required, and separate and apart from the credentialing process with any MCO.
Every 2 months, Louisiana Medicaid will send invitation letters to new providers not yet enrolled with Louisiana Medicaid. These letters include detailed instructions and specific provider information required for enrollment. Providers must complete enrollment within 120 days of receiving the letter to avoid claim denials and potential deactivation from the Medicaid program.
Billing, attending, rendering, ordering, servicing, prescribing or referring providers on recent claim(s) filed with Louisiana Medicaid must enroll directly with Louisiana Medicaid to avoid claims denials and remain active.
Providers with multiple provider types must complete an enrollment for each type.
To access the portal, visit lamedicaid.com and click on the blue banner to begin the enrollment process.
Providers will need several data points to complete enrollment, including Louisiana Provider ID, NPI, city, state and ZIP code. This information is included in the portal invitation letter.
If you have any questions or concerns, you can reach out to Louisiana Medicaid.
866-675-1607
Use this one-call resource line to get the following information:
If your office relocates or closes for an extended period, please call us at 877-369-1302.
We also have a dedicated team of community provider advocates available statewide to support provider needs.
UnitedHealthcare Community Plan
P.O. Box 31341
Salt Lake City, UT 84131-0341
UnitedHealthcare Community Plan
Attn: Claims Administrative Appeals
P.O. Box 31364
Salt Lake City, UT 84131-0364
UnitedHealthcare Community Plan
Attn: Claims Administrative Appeals
P.O. Box 31364
Salt Lake City, UT 84131-0364
We want to help make sure your patients are prepared for hurricane season and the resulting hazards such as storm surge, high winds, tornadoes and flooding.
You can find more information at the Louisiana Department of Health's Louisiana Volunteers in Action (LAVA).
In case of a hurricane or other disaster, your patients can register on the American Red Cross Safe and Well website to let family and friends know about their welfare. Those without Internet access can call 866-GET-INFO.
Thank you for your interest in becoming a network care provider with UnitedHealthcare Community Plan of Louisiana. 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 get started, follow the steps to join our network. You may refer to the state-specific credentialing requirements for Louisiana Community plan in the UnitedHealthcare Community Plan Care Provider Administrative Guide.
UnitedHealthcare adheres to the Louisiana Revised Statute 22:1874 (which incorporates Act 897) for practitioners joining an existing, contracted medical group to be temporarily approved to receive claims payment upon submitting their completed UnitedHealthcare application, and then will be fully credentialed upon application approval.
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.
The Centers for Medicare & Medicaid Services (CMS) established the Medicaid Managed Care Rule to:
With the Medicaid Managed Care Rule, CMS updated the type of information managed care organizations are required to include in their care provider directories.
UnitedHealthcare Community Plan maintains a grievance system for members that ensures receipt and prompt resolution of informal and formal member grievances and access to the state fair hearing process.
A member, a representative of the member's choice, or a provider, acting on behalf of the member with the member's written consent, may file a grievance with UnitedHealthcare Community Plan.
Grievances may be filed orally by calling Member Services at 866-675-1607 or in writing by mailing the grievance to our Regional Mail Operations (RMO) at:
UnitedHealthcare
P.O. Box 31364
Salt Lake City, UT 84131-0364
We route telephonic/verbal grievances through our technology that identifies call type and routes to other databases according to category. When the system identifies the call as a grievance, the information is logged into the system, and forwarded to a triage team who puts the information into our tracking system where a case file is created and populated.
On receipt of a written grievance, appropriate personnel scan them into the tracking system and create a case file.
Per our Member Grievance Policy, and on initial contact, we log and track criteria including member.
Visit UHCcommunityplan.com/LA for current member plan information including sample member ID cards, provider directories, dental plans, vision plans and more.
Plan information is available for:
Member plan and benefit information can also be found at UHCcommunityplan.com/LA and myuhc.com.
Member dental plan and benefit information can also be found at UHCcommunityplan.com/LA and myuhc.com.
Dental Benefits for enrollees under the age of 21 may be managed by DentaQuest or Managed Care of North America (MCNA). Both providers are premier dental benefits administrators that provide exceptional service to State Agencies and managed care organizations for Medicaid. For benefits, claims, provider enrollment, direct deposit issues, demographic changes, NPI information, etc., contact:
We provide dental benefits for enrollees over 21 through value-added benefits. Enrollees over age 21 get up to $500 per year for routine dental exams, X-rays and cleanings. For benefits, claims, provider enrollment, direct deposit issues, demographic changes, NPI information, etc., contact:
Enrollees vision plan and benefit information can be found at UHCcommunityplan.com/LA and myuhc.com.
March Vision Care is the vision vendor for UnitedHealthcare and provides routine vision services including:
Phone: 844-52-MARCH or 844-526-2724
Online: marchvisioncare.com/providerreferenceguides.aspx
Mailing address for claims:
Claims Processing Center
6701 Center Drive West, Suite 790
Los Angeles, CA 90045
For all other vision services, please contact UnitedHealthcare Community Plan at 866-675-1607.
Note: Vision services performed by an optometrist are reimbursable for routine and non-routine services. Claims must be submitted to March Vision Care for processing. This is due to the expanded scope of the services the Louisiana Board of Optometry now allows optometrists to perform in the office setting.
The Louisiana Department of Health (LDH)/Office of Behavioral Health (OBH) is in the process of expanding upon and restructuring the Medicaid service delivery system related to crisis services.
Crisis Response phone: 866-232-1626
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:
For help using CommunityCare, please see our quick reference guide. If you’re not familiar with our portal, go to our portal resources page.
Member Primary Care Physician Reassignment
Check out Care Conductor in the UnitedHealthcare Provider Portal under Clinical & Pharmacy.
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.
Email us at ethics-integrity_office@uhc.com, call us at 844-359-7736 or visit uhc.com/fraud to report any issues or concerns.
Providers may submit all private third-party liability (TPL) requests and Medicare Advantage plan updates to Health Management Systems, Inc. (HMS), the Louisiana Department of Health (LDH) TPL vendor.
All general private TPL and Medicare Advantage plan update requests can be submitted to HMS in the following ways:
Providers may submit TPL escalation requests to LDH by:
Please note, escalated requests will only be accepted in the following circumstances:
Looking for Traditional Medicare update request forms? Find them here.
You can find additional information in Informational Bulletin 16-15.
The latest version(s) of the UnitedHealthcare Community Plan 2023 Contract and Amendments of the Healthy Louisiana contract is available on the Louisiana Department of Health website.
View the UnitedHealthcare Community Plan 2023 Contract and Amendments for Healthy Louisiana
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.
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.
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 UnitedHealthcare 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.