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Provides operational guidance for physician, care provider, facility, and ancillary participants, including claim processing, prior authorization requests, and where to find important phone numbers and websites. Describes the integrated managed care model, contractor risk agreement structure, and program governance, plus how updates are submitted for review and approval. Includes references for CHOICES/ECF CHOICES long-term services and support coordination and directs readers to related provider manuals and glossary definitions.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/care-provider-manual-unitedhealthcare-community-plan/640736/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/care-provider-manual-unitedhealthcare-community-plan/640736.png","ImageObject",300,407,{"name":92,"@type":93},"Fahsai","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-05","2026-10-22",true,{"@type":102,"interactionType":103,"userInteractionCount":52},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What key operational topics are covered in the care provider manual?","Question",{"text":112,"@type":113},"The manual explains how to process claims and submit prior authorization requests, and it provides important contact information and website resources for operational needs.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How is TennCare managed under UnitedHealthcare Community Plan in Tennessee?",{"text":117,"@type":113},"TennCare members are enrolled into a managed care organization (MCO) by geographic region, and UnitedHealthcare Community Plan administers the program as a primary care practitioner (PCP)-driven HMO network with an integrated care model.",{"name":119,"@type":110,"acceptedAnswer":120},"How are updates to the care provider manual handled?",{"text":121,"@type":113},"Information is updated at least semi-annually and submitted to TDCI, Division of TennCare Oversight for review and written approval, with updates submitted within 60 calendar days before the effective dates of the semi-annual amendment (January 1 and July 1).","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},640736,1793069400,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":52,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":139,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145,"preview_page_count":4},549768702563,"https://ap-avatar.wpscdn.com/avatar/8000c4aa63b76e948b?x-image-process=image/resize,m_fixed,w_180,h_180&k=1786536092046926083","Care Provider Manual  \nPhysician, Care Provider, Facility, and Ancillary  \nTennessee  \nDoc\\#: PMI 07202026-080017  \nWelcome  \nWelcome to the UnitedHealthcare Community Plan® care provider manual. This up-to-date reference PDF care provider manual allows you and your staff to find important information, such as how to process a claim and submit prior authorization requests. This care provider manual also includes important phone numbers and websites on the How to Contact Us page. Find operational policy changes and other electronic [transactions on our website at](transactions on our website at UHCprovider.com)[ UHCprovider.com](transactions on our website at UHCprovider.com).  \nThis care provider manual supports TennCare, Tennessee’s Medicaid program. It has been operating under a waiver from CMS since 1994 to offer coverage to the traditional Medicaid-eligible population as well as an expanded population (TennCare Standard). All TennCare members are enrolled into a managed care organization (MCO) within their geographic region. We entered into a Contractor Risk Agreement (CRA) for each Grand Region with the State of Tennessee for provision of the TennCare benefits. The TennCare program in each Grand Region is governed by its CRA, the TennCare rules and regulations as well as the TennCare policies. The Division ofTennCare website contains links to all governing documents. These include:  \n• CRA: [tn.gov](tn.gov)  \n• TennCare rules: publications.tnsofi[les.com](les.com)  \n• TennCare policies: [tn.gov](tn.gov)  \nWe administer the TennCare program as an MCOin all 3 geographic regions doing business as UnitedHealthcare Community Plan. We are a primary care practitioner (PCP)-driven HMO network focusing on PCPs providing appropriate care to covered persons based on established clinical guidelines. We operate in an integrated model where all physical, behavioral, and Long-Term Services and Supports (LTSS) health care needs are assessed, coordinated and monitored. We offer our covered individuals and care providers programs in medical management, quality improvement, education and development, as well as quality customer service.  \nSome TennCare enrollees are also eligible for enhanced services provided through CHOICES/ECF CHOICES. CHOICES/ECF CHOICES is the LTSS program, which promotes quality and cost-effective care coordination for CHOICES/ECF CHOICES enrollees with chronic, complex health care, social service, and custodial needs.  \nCHOICES/ECF CHOICES care coordination operates based on our fully integrated model so the physical, behavioral and LTSS care health needs of the CHOICES/ ECF CHOICES enrollees are met. You may find detailed information on the CHOICES/ECF CHOICES program in Chapter 6: Long-Term Services and Supports (LTSS) of this manual.  \nInformation in this care provider manual shall be updated at least semi-annually and submitted to TDCI, Division ofTennCare Oversight for review and written approval. Updates are submitted within 60 calendar days prior to the effective date of the semi-annual amendment to the CRA: January 1 and July 1 of each calendar year.  \nClick the following links to access different care provider manuals  \n• LTSS Employment Benefits Supplemental Guide  \n[UHCprovider.com/guides](UHCprovider.com/guides)  \n• UnitedHealthcare Care Provider Administrative Guide for Commercial, Medicare Advantage (including Dual Complete Special Needs Plans) member information. Some states may also have Medicare Advantage information in their Community Plan manual.  \n• A different state Community Plan manual: go to [UHCprovider.com](UHCprovider.com) > Resources > Care Provider Administrative Guides and Manuals > Community Plan Care Provider Manuals for Medicaid Plans by State.  \n• UnitedHealthcare Dual Complete: For information about UnitedHealthcare Dual Complete in Tennessee, [go to](go to UHCprovider.com)[ UHCprovider.com](go to UHCprovider.com) > Resources > Health Plans choose state > Tennessee Medicare Advantag","cbCaieYjAqpSUPC2","https://ap.wps.com/l/cbCaieYjAqpSUPC2","pdf",1838111,132,"English","# Welcome\n## Using this care provider manual\n## Participation Agreement\n## CHOICES/ECF CHOICES and LTSS\n## Updates, amendments, and review process","[{\"question\":\"What key operational topics are covered in the care provider manual?\",\"answer\":\"The manual explains how to process claims and submit prior authorization requests, and it provides important contact information and website resources for operational needs.\"},{\"question\":\"How is TennCare managed under UnitedHealthcare Community Plan in Tennessee?\",\"answer\":\"TennCare members are enrolled into a managed care organization (MCO) by geographic region, and UnitedHealthcare Community Plan administers the program as a primary care practitioner (PCP)-driven HMO network with an integrated care model.\"},{\"question\":\"How are updates to the care provider manual handled?\",\"answer\":\"Information is updated at least semi-annually and submitted to TDCI, Division of TennCare Oversight for review and written approval, with updates submitted within 60 calendar days before the effective dates of the semi-annual amendment (January 1 and July 1).\"}]","Care Provider Manual - UnitedHealthcare Community Plan | PDF",1792711233,333]