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.
Health care professionals seeking initial credentialing with New Mexico Medicaid Managed Care Organizations (MCOs) should use our new centralized credentialing process. The New Mexico Health Care Authority (HCA) has approved CertifyOS, a National Committee for Quality Assurance (NCQA)‑Certified Centralized Verification Organization (CVO) to support the credentialing process for the following MCOs:
Working with CertifyOS
Outreach on missing information identified during credentialing or recredentialing will be handled by CertifyOS. Please respond to their requests. Nonresponse will result in delays in the credentialing or recredentialing process and could delay contract effective dates.
CertifyOS will be responsible for facility credentialing, as well as credentialing for medical, behavioral health and substance use providers. Vendors or entities that hold delegated credentialing agreements (e.g., physical health, routine vision, pharmacy, non-emergency medical transportation or other entities, including independent physician associations and physician hospital organizations) are excluded.
Note: Centralized credentialing does not replace the Medicaid provider enrollment screening process. All Medicaid providers must enroll with the program through the New Mexico HCA.
Recredentialing
Recredentialing for facilities and providers under this new process will begin September 2026 and occur every 3 years unless completed by a delegated entity. CertifyOS will initiate recredentialing outreach 6 months before the recredentialing due date.
What you’ll need to start the process
This centralized process adheres to NCQA and CMS federal guidelines. To begin the practitioner credentialing process, providers must have:
To begin the facility credentialing process, facilities must have:
Sign in to the UnitedHealthcare Provider Portal with your One Healthcare ID. This allows you to access self-service tools and connect with us by visiting our contact resources. Please have the care provider’s full name, tax ID number (TIN) and National Provider Identifier (NPI) number available.
Resources
If you have any questions, please contact the appropriate MCO(s):
For questions about Credentialing and Attestation updates, connect with us through chat 24/7 in the UnitedHealthcare Provider Portal.
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 in the UnitedHealthcare Provider Portal, which allows you to:
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.
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.