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Provider Forms and References | UnitedHealthcare Community Plan of Minnesota

See the forms below to stay up-to-date on changes and other issues that are important to your practice.

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General Forms

Community Plan of Minnesota Restricted Recipient Program Patient Referral Request Form

Health Homes

Contact Provider Call Center 1-877-440-9946, available from 8:00 a.m. - 5:00 p.m. Central Time.

Submit a Pre-Service Appeal and or Grievance for a Medicaid Member

Medicaid Pre-Service Appeal or Grievance