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UnitedHealthcare Community Plan of Mississippi Homepage

Medicaid to implement a single Pharmacy Benefit Administrator


REMINDER - The Mississippi Division of Medicaid will implement the single Pharmacy Benefit Administrator effective July 1, 2024.

Please refer to DOM's Late Breaking News for crucial updates related to a single Pharmacy Benefit Administrator at Medicaid to implement single Pharmacy Benefit Administrator - Mississippi Division of Medicaid (ms.gov).

Validate recredentialing status with Mississippi Medicaid


Please validate your recredentialing and revalidation status with the Mississippi Division of Medicaid (DOM). This will help ensure uninterrupted maintenance of your enrollment status and continued provision of essential health care services to our community.

For crucial updates related to revalidation and recredentialing, refer to MESA Portal for Providers - Mississippi Division of Medicaid (ms.gov).

To verify your recredentialing and revalidation dates, use the Mississippi DOM Provider Search Tool and your NPI.

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.

Prior Authorization and Notification Resources

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Current Policies and Clinical Guidelines

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Provider Administrative Manual and Guides

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Contact Us

Contact Us

Contract, Demographic, and Network Related Issues: 800-557-9933

Claims or Service Related Questions: 800-557-9933

Provider Customer Service Hours of Operation: 8:00 am - 6:00 pm CST

Postal Mailing Address

UnitedHealthcare
795 Woodlands Parkway, Suite 301
Ridgeland, MS  39157

Claims Mailing Address

UnitedHealthcare
P.O. Box 5032
Kingston, NY  12402-5032

For questions about Credentialing and Attestation updates, connect with us through chat 24/7 in the UnitedHealthcare Provider Portal.

All MississippiCAN and CHIP providers must be credentialed through the Mississippi Division of Medicaid’s Medicaid Enterprise System Assistance (MESA) provider portal.

Once your credentialing is complete with the Mississippi Division of Medicaid and you have an active MS Medicaid ID number, submit your practice’s letter of intent or request for participation by contacting us through chat within the UnitedHealthcare Provider Portal. Once the Mississippi Division of Medicaid’s credentialling process is complete, contact UnitedHealthcare to request a participation agreement to join our network. You should receive a reference number (starts with PR) for your request within an hour. If you have not received a PR number within 24 business hours, please double-check your spam or junk folders before resubmitting. Please do not copy anyone on your participation request, as this can cause a submission error that prevents your letter from being received.

As part of your application, please include a statement that the practice is requesting a new medical group agreement, along with the specific medical group specialty, practice roster and copies of Form W-9. The average turnaround time for demographic loading is 30 days, with an additional 30–45 days for completion of the contract process. Please be aware that credentialing approval does not imply or guarantee participation with our health plans. Approved and signed physician contracts are required for participation.

Learn more about the steps needed to join our network of providers in Mississippi.

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/MS for current member plan information including sample member ID cards, provider directories, dental plans, vision plans and more.

Member plan and benefit information can also be found at UHCCommunityPlan.com/MS and myuhc.com/communityplan.

CommunityCare

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:  

  • Identify Medicaid recipients who need to have their Medicaid recertification completed and approved by the state in order to remain eligible to receive Medicaid benefits
  • See a complete list of all members, or just members added in the last 30 days
  • Export the roster
  • View most Medicaid and Medicare Special Needs Plans (SNP) members’ plans of care and health assessments
  • Enter plan notes and view notes history (for some plans)
  • Obtain HEDIS information for your member population
  • Access information about members admitted to or discharged from an inpatient facility
  • Access information about members seen in an emergency department

For help using CommunityCare feature on the UnitedHealthcare Provider Portal, please see our Quick Reference Guide. If you’re not familiar with UnitedHealthcare Provider Portal, visit our Portal Resources page.

Go to CommunityCare Now
CommunityCare Overview

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, UnitedHealthcare works to detect, correct and prevent fraud , waste  and abuse  in the health care system.

Call us at 1-844-359-7736 or at uhc.com/fraud to report any issues or concerns. 

UnitedHealthcare Dual Complete® Special Needs Plan

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.

Learn more about the Dual Special Needs Program

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 Healthcare Common Procedure Coding System (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 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.