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UnitedHealthcare Community Plan of New Mexico Homepage

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.

Primary Care Payment Reform Provider Registration

Primary Care Payment Reform (PCPR) Value-Based Payment (VBP) Program: Eligibility screening and registration opens on Monday, September 16, 2024. Register by October 14th to maximize your quality bonus payment

See the details

Prior Authorization and Notification Resources

Behavioral health inquiries: 877-440-9946

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Current Policies and Clinical Guidelines

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Provider Administrative Manual and Guides

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Provider Services Call Center

  • Phone: 888-702-2202; available 8 a.m. – 5 p.m. Mountain Time, M-F

Provider Relations

Technical Support

  • Phone: 866-209-9320

Behavioral Health Services

  • Phone: 877-440-9946 available 8 a.m. – 5 p.m. Central Time, M-F
  • Online: providerexpress.com

Pharmacy Services

  • Pharmacies call: 800-970-3887
  • Prescribers requesting Pharmacy Prior Authorization call: 800-310-6826 or submit prior authorization through CoverMyMeds or SureScripts.

UnitedHealthcare Dental

MARCH Vision Care

TripMaster for Nonemergency Medical Transportation Services

  • Phone: 877-236-0826
    Call to schedule at least three days in advance

HCBS Provider Relations Manager

EVV Inquiries

Care Coordination Inquiries

Housing Stabilization/Food Insecurity Liaison

Children's Services and School-Based Health Liaison

Justice-Involved Liaison

IDD/Medically Fragile Liaison

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.

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/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:

  • UnitedHealthcare Community Plan of New Mexico

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

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

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. 

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 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.