UnitedHealthcare Community Plan preps for entry into additional Medi-Cal and Medicare Advantage markets August 23, 2018 Managed Care, Medi-Cal, Medicare Commercial Payors, Payor Contracting, Public Payors 0 Looking to potentially enhance its footprint in the Medi-Cal and Medicare Advantage marketplace by 2021, UnitedHealthcare (UHC) Community Plan of California has issued unilateral contract amendments to contracted physicians in seven California counties. Additionally, UHC providers in the seven counties who are not currently contracted for the Medicare Advantage product will receive a combined contract amendment for participation in both UHC Community Plan of California (Medi-Cal) and UHC Medicare Advantage products. As a condition of participation in the Medi-Cal Managed Care request for proposal process in late 2019 or early 2020, UHC must demonstrate an adequate network of participating providers as part of its bid to the Department of Health Care Services (DHCS). Under the terms of the amendment, physicians will automatically be opted into the Medicare Advantage network and/or Community Plan network unless a written request to opt out has been submitted to UHC Community Plan within 45 days of receipt of the amendment. Physicians may opt out of the amendment without affecting their underlying UHC commercial contracts by issuing a letter to: UnitedHealthcare Physician Contracting 780 Shiloh Road Plano, TX 75074 Physicians with questions regarding the amendment can contact UnitedHealthcare’s Network Management Resource Team at (866) 574-6088. UnitedHealthcare Community Plan first launched into the Medi-Cal Managed Care program in Sacramento and San Diego counties beginning October 1, 2017. However, after only a year in the program, UHC recently issued notice that it will no longer provide services to approximately 4,400 Medi-Cal members in Sacramento County, effective November 1, 2018. The notices mailed to Community Plan physicians in July 2018 advise that DHCS will transition all UHC Community Plan members in Sacramento County to other participating Medi-Cal Managed Care plans by November 1. UHC Community Plan members who need assistance in selecting an alternative Medi-Cal health plan or who have questions regarding transitioning to a new plan can be directed to Health Care Options at (800) 430-4263. Physicians with questions regarding the transition should contact UHC Provider Services at (866) 270-5785. Comments are closed.
