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 need. Be sure to check back often for updates.
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.
The state-specific requirements and process on how to join the UnitedHealthcare Community Plan network are found in the UnitedHealthcare Community Plan Care Provider Manuals.
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.
Learn more about the UnitedHealthcare Community Plan home visiting care provider onboarding process.
Overview
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.
Visit UHCCommunityPlan.com/NM for current member plan information including sample member ID cards, provider directories, value-added benefits, dental plans, vision plans and more.
Plan information is available for:
Member plan and benefit information can be found at UHCCommunityPlan.com/NM and myuhc.com/communityplan/NM.
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.
Reporting Fraud, Waste or Abuse to Us
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.
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 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, refer to Bulletins and Newsletters | UnitedHealthcare Community Plan of New Mexico.
UnitedHealthcare Community Plan of New Mexico is a product of UnitedHealthcare Insurance Company.