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UnitedHealthcare Community Plan of Rhode Island 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're looking for. Be sure to check back frequently for updates.

Are you a member looking for health plan or provider information?

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21st Century Cures Act – Screening / Enrollment


Effective November 1, 2023, providers must be screened/enrolled with RI Fee for Service Medicaid to avoid claim denials and network termination. 

Do you file claims with Rhode Island Medicaid? Keep your billing privileges by completing your state screening and enrollment.

Prior Authorization and Notification Resources

Learn More

Current Policies and Clinical Guidelines

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Provider Administrative Manual and Guides

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

Connect with us through chat 24/7 in the UnitedHealthcare Provider Portal. For additional contact information, visit our Contact us page.

Provider Call Center

1-855-766-0344 - 24 hours a day, 7 days a week and holidays

Mailing Address

UnitedHealthcare Community Plan
Attn: Medicaid Program
475 Kilvert Street
Warwick, RI 02886

Utilization Management Appeals Address

UnitedHealthcare Community Plan
P.O. Box 31364
Salt Lake City, Utah 84131

340B Billing

  • Drugs billed to the medical benefit for applicable 340B claims-
    • Modifier: UD
    • Description: Medicaid level of care 13, as defined by each state
  • Drugs billed to the pharmacy benefit for applicable 340B claims-
    • NCPDP field 409-D9: Ingredient Cost Submitted = 340B Acquisition Cost with the associated value 08 in NCPDP field 423-DN: Cost Basis
    • NCPDP field 420-DK: Submission Clarification Code = 20

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.

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

Plan information is available for:

  • Rhode Island Children with Special Health Care Needs
  • Rhode Island UnitedHealthcare Rhody Health Partners ACA Adult Expansion
  • Rhode Island UnitedHealthcare Rhody Health Partners
  • Rhode Island UnitedHealthcare RIte Care

Member plan and benefit information can also be found at UHCCommunityPlan.com/RI 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

To help you more easily deliver care to UnitedHealthcare Community Plan of Rhode Island members, we’re removing the referral requirement for members who see in-network specialists. Therefore, claims will not be denied for covered services because there is no referral in the system.

This change to the referral requirements doesn’t affect existing prior authorization and notification requirements.

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.