August 23, 2018
Area(s) of Interest: Commercial Payors Payor Contracting Public Payors
Looking to potentially increase its presence in the Medi-Cal and Medicare Advantage marketplace by 2021, UnitedHealthcare (UHC) Community Plan of California is building its provider network and has issued unilateral contract amendments to some contracted physicians in seven California counties.
Select 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 entered the Medi-Cal Managed Care market in Sacramento and San Diego counties on October 1, 2017. However, after only a year in the program, UHC recently announced that it will no longer provide services to approximately 4,400 Medi-Cal members in Sacramento County, effective November 1, 2018.