Provider Directory - UHCCommunityPlan.com

702 Pages·2013·5.31 MB·English

Provider Directory
Directorio de proveedores
New Mexico Centennial Care

New Mexico Service Delivery Area:
All counties within the State of New Mexico.
Área de servicio de New Mexico:
Todos los condados dentro del estado de New Mexico.
Member Services
Servicios para miembros
Monday – Friday / Lunes a viernes de 8 a.m. to/a 5 p.m. MST
1-877-236-0826
(TTY: 711)
www.uhccommunityplan.com
517-1023 1/14
NM Medicaid
10/21/2013
NMMA
Important Phone Numbers
UnitedHealthcare Community Plan Member Services

(8 a.m. to 5 p.m. MST, Monday through Friday) . . . . . . . . . . . . . . . . . . 1-877-236-0826
TTY (Hard-of-hearing) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 711
24/7 NurseAdvice New Mexico . . . . . . . . . . . . . . . . . . . . . . . . . . 1-877-725-2552
(available 24 hours a day, 7 days a week)
TTY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 711
EPIC Hearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-866-956-5400
Transportation – Managed by LogistiCare

LogistiCare Reservations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-866-913-2492
Ride Assistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-866-913-2493
(TTY: 1-866-288-3133)
Dental (UnitedHealthcare Dental Benefits) . . . . . . . . . . . . . . . . 1-877-236-0826
To see a list of providers, visit our website at www.UHCCommunityPlan.com
IN CASE OF AN EMERGENCY DIAL: 911
This document contains important information. Call toll-free 1-877-236-0826 (local customer
service) to get the document in another language or have it orally translated for you.
www.UHCCommunityPlan.com
Welcome
Welcome to UnitedHealthcare Community Plan.
You made a smart choice in health care programs. This directory provides a list of your plan’s network providers.
We work closely with our doctors, hospitals, and other providers to get you the care you need. This directory is for
the State of New Mexico’s Centennial Care Program.
About Centennial Care
Centennial Care is a Medicaid managed care program from the New Mexico Human Services Department.
Managed care means that the State of New Mexico hires a company, also known as a Managed Care Organization
(MCO), to help you manage your health care.
To get the most up to date information about the providers in your area, you can visit
www.uhccommunityplan.com
or you have the right to request an updated copy from our Member
1-877-236-0826 TTY: 711
Services Department at ( for people who are hearing impaired). The call is free.
If you have an emergency, call 911 or go to an emergency room.
Transportation
LogistiCare manages your transportation benefit. They offer routine transportation to medical, dental and
behavioral health appointments. You can reach a representative 8:00 a.m. – 5:00 p.m. Monday – Friday. The
reservation line is closed on national holidays and weekends.
Language Help
We can get you materials in a language or format that is easier for you. If you have questions, call us. Our toll-free
number is 1-877-236-0826. There are people who can talk with you in English, Spanish, or other languages. If
you need an interpreter, tell us. We will connect you to the AT&T Language Line. If you are speech or hearing
impaired, call TTY 711. Call us if you need this book in Braille, large print, audio, or another language.
For help to translate or understand this, call 1-877-236-0826 (TTY: 711).
Si necesita ayuda para traducir o entender este texto, por favor llame al telefono
1-877-236-0826 (TTY: 711).
Providers in this directory are current as of the date on the cover.
The online provider directory is updated more frequently than the printed directory.
The information is subject to change.
www.UHCCommunityPlan.com
NMMA
Member Services
Member Services 1-877-236-0826 (TTY: 711)
Our office is closed on these major holidays:
New Year’s Day (observed) Labor Day
Memorial Day Thanksgiving Day
Independence Day Christmas Day (observed)
Our friendly representatives are Member Services can also connect you
available to help you. If you call Toll- with your Care Coordinator if you need
1-877-236-0826 (TTY: 711)
free . information about health care, such as:
Our Member Services team has • Living with a chronic illness
information on:
• Disease Management program
• Membership
• How to get behavioral care
• Choosing a primary care provider
• Eating healthy foods
• Specialists, hospitals, and other providers
• Safe sex and birth control
• Covered services
• HIV/AIDS
• Changing doctors
• Keeping children well with
• Making a complaint EPSDT services
• Name or address changes
We are happy to help with other topics. Just
• Medicaid and Medicare coverage 1-877-236-0826
call . If you are speech or
• Getting an interpreter TTY: 711
hearing impaired, call . You can
• Getting a ride to the doctor call 24 hours a day. For medical questions,
• Prior authorization questions you can talk to someone at any time. For
non-medical questions, leave a message.
• Other questions
www.UHCCommunityPlan.com
Care Coordination
What to Do in Case
Care coordination helps you get access to the care you
need. UnitedHealthcare Community Plan has Care of an Emergency
Coordinators for anyone in Centennial Care. Care
Coordinators help you meet your health needs. A An emergency is a serious accident or medical issue
Care Coordinator is your main point of contact. They that, if not treated quickly, could be life-threatening.
may contact you by phone or in person depending on Examples are:
your level of need. A Care Coordinator does not • Unstoppable bleeding.
provide direct care services, such as home health care,
• Broken bone.
meal preparation, therapy, etc. A Care Coordinator is
• Passing out or fainting.
someone that looks at your physical and/or behavioral
• Severe stomach or chest pain.
health needs and works directly with you and your
family, to get the services needed to improve your health. • Poisoning.
• Convulsions or seizures.
How do I get a Care Coordinator?
• Trouble breathing.
A Care Coordinator will be assigned to you. They will • Signs of a heart attack or stroke.
contact you by phone. If they are unable to reach you, • Severe or multiple injuries or burns.
you will receive a letter from your Care Coordinator.
1-877-236-0826 If you have a medical emergency, get help as quickly
Call your Care Coordinator at if
911
as possible. Call or go to the nearest emergency
you have questions or need help.
room or hospital. Prior authorization is not required
When will I meet my for emergency services. You can always get emergency
care from the nearest available provider, whether or
Care Coordinator?
not they are a network provider.
Your Care Coordinator will contact you when you Emergency care is covered by UnitedHealthcare
join. If you are new to UnitedHealthcare Community Community Plan 24 hours a day, 7 days a week. It
Plan, we will contact you within 30 days. The State does not matter where you are in the United States.
may notify us of members with urgent needs and we
will contact you within 7 days. If you are switching Choosing a Primary
from another Centennial Care MCO, we will contact
Care Provider (PCP)
you within 60 days. Your Care Coordinator will meet
with you at least once a year.
1. I f you only have Centennial Care Medicaid
coverage: You must pick a primary care provider
UnitedHealthcare Community
from this list. Your primary care provider will
Plan Translation Services work with your Care Coordinator. A primary care
provider is a doctor, clinic, or specialty nurse that
If you need an interpreter or help in another language, helps with most of your care needs.
1-877-236-0826
call . Members who are hearing
TTY: 711 2. I f you have Centennial Care Medicaid with
impaired call . We have materials in English
Medicare primary coverage: Your Medicare will
and Spanish. We can help you get information in other
not change. You do not have to pick a new doctor.
languages. We can get a translator (including sign
language) for doctor visits and Care Coordinator meetings.
www.UHCCommunityPlan.com
Your Primary Care Provider (PCP) is your personal If your current doctor is a specialist, he or she may
care doctor. A primary care provider is a doctor, clinic, be able to act as your regular doctor. You must get
or specialty nurse who helps you with most of your permission from UnitedHealthcare Community Plan.
1-877-236-0826
health care needs. After you pick a regular doctor, call
(TTY: 711)
and give them the name. If the doctor you
Your PCP will give or manage most of your health
have now is not with Centennial Care, we will help you
care. Talk to your PCP about any health problems you
pick a new doctor. If you do not pick a doctor, we will
have. Let your PCP know about your medical history.
pick one for you. You can call Member Services to
Tell them about any specialists that you are seeing and
change your provider any time.
follow all your PCP’s instructions.
UnitedHealthcare Community Plan will send you
Part of good health is seeing your PCP for checkups,
your doctor’s name, address, and phone number. If you
even if you don’t feel sick. UnitedHealthcare
have Medicare, you will not have to pick a doctor.
Community Plan will send you a reminder so you
know when to go for a checkup. When you don’t feel UnitedHealthcare Community Plan’s provider network
well, your PCP will help you. Be sure to call your PCP frequently changes. For a current list, call Member
1-877-236-0826
right away. Your PCP may refer you to a specialist. Services at . If you are hearing
TTY: 711
impaired, call . The call is free.
If you have a doctor you like, you can stay with
that doctor if he or she is in the UnitedHealthcare You can also see the list at
www.UHCCommunityPlan.com
Community Plan network.
Special Note for Members who have Medicare and Medicaid:
This section is for members who have both Medicare and Medicaid.
If you have traditional Medicare, you can keep your regular doctor. You can use a specialist
without checking with UnitedHealthcare Community Plan. Tell your Care Coordinator the name
of your doctor. If you pick a new doctor, tell your Care Coordinator.
If you have traditional Medicare and do not have a doctor, UnitedHealthcare Community Plan
can help you pick one.
If you belong to a Medicare HMO, your regular doctor will be the one you already use. You do not
have to pick another doctor for Centennial Care. Your Medicare doctor will work with your Care
Coordinator to help with your Centennial Care services. Tell your Care Coordinator the name of
the doctor you use with Medicare. If you need help, call Member Services at 1-877-236-0826
or TTY: 711. The call is free.
If you have Medicare, your doctor does not have to call UnitedHealthcare Community Plan to
send you to a specialist. Tell your Care Coordinator about any specialist you are using. Your Care
Coordinator can make sure you are helped quickly by your specialist. Your Care Coordinator can
also help with follow-up care.
www.UHCCommunityPlan.com
Access to Obstetricians Other UnitedHealthcare
and Gynecologists Community Plan Facilities
and Providers
Women may pick an obstetrician (OB) or gynecologist
(GYN) to give care. If you go directly to an
The following types of providers are in the
OB/GYN, you do not need a referral from your
UnitedHealthcare Community Plan network.
doctor. The OB/GYN must be in UnitedHealthcare
Your doctor or Care Coordinator must order
Community Plan’s provider network. Your Care
these services.
Coordinator can help you pick an OB/GYN.
• Durable medical equipment suppliers
Special options for
• Dialysis centers
Native American members • Lab services
• X-ray/imaging centers
Native American members may go to any Indian
• Vision care
Health Service (IHS) or Tribal health care facility.
• Dental services not including preventive
You do not need a referral from your doctor or
UnitedHealthcare Community Plan. • Prosthetics and orthotics suppliers
• Hearing services
Family Planning Providers
• Surgical centers
When you need family planning or birth control, you
UnitedHealthcare Community Plan’s provider
can go to your doctor or a family planning provider.
network grows every day. For a current list,
You do not need a referral from your doctor. Anything
call UnitedHealthcare Community Plan
you tell the family planning provider is kept private. 1-877-236-0826
Member Services at . If you
Your Care Coordinator can help you find a family TTY: 711
are hearing impaired, call . The call
planning provider. For family planning services you
is free. You can also see a list of providers at
may see any doctor, even if they are not contracted www.myuhc.com/communityplan
.
with UnitedHealthcare Community Plan.
www.UHCCommunityPlan.com
How to Use This Directory
Choosing a Primary Care Physician (PCP) for you
and your family is easy.
There are several types of PCPs listed here.
Primary Care Physicians
Family Medicine: Adults and Children
Pediatrics: Children
Internal Medicine: Adults
General Practice: Adults and Children
OB/GYN: Adult Women
(who specifically request
to act as a PCP)
Physician’s Assistants: Adults and Children
Nurse Practitioners: Adults and Children
Geriatrics: Adults
Clinics: Adults and Children
(to include IHS, FQHC, RHC)
To find a provider, find your county in the table of contents. The providers are listed by their specialty.
When you find the specialty you want, go to the page listed. Then you can pick the provider who meets
your needs. Members may get care from a resident doctor or a nurse practitioner if supervised by a PCP.
If there is no chapter in the Table of Contents for the type of provider you want, look in the chapter for
Ancillary Providers. Providers that do not have specific chapters are listed there.
Sample listings are on the next page.
www.UHCCommunityPlan.com
Description of Listings
Board Certification
Provider Listing shows a doctor’s
specialty. It requires testing in the specific
Provider Name John Smith, MD*
area of medicine. A specialist has
Address 123 Main Street
continuing education on the latest advances
Health Valley, NM 54321
in his or her specialty. You can check the
Phone Number 222-222-2222 provider’s certifications on the American
Board of Medical Specialists (ABMS)
Board Certification Family
www.abms.org
website. Go to . Click on
Languages Spanish
“Is Your Doctor Certified?”
Limitations Closed Panel
Languages
other than English the
provider speaks.
Hospital Listing Limitations
of the practice. An example is
Hospital Name GoodCare Hospital Closed Panel. (This means they do not take
new patients.)
Hospital Address 123 Main Street
Health Valley, NM 54321
Wheelchair
shows they have
Phone Number 222-222-2222
wheelchair access.
All of the information here comes from the provider’s application. UnitedHealthcare checks this when they join
our network. We check it again every three years (or sooner).
www.UHCCommunityPlan.com
Números de teléfono importantes
Servicios para Miembros de UnitedHealthcare Community Plan

(8 a.m. to 5 p.m. MST, lunes a viernes) . . . . . . . . . . . . . . . . . . . . . . . . 1-877-236-0826
TTY (para problemas de audición) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 711
24/7 NurseAdvice New Mexico (línea de enfermeras) . . . . . . 1-877-725-2552
(disponible 24 horas al día, 7 días de la semana)
TTY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 711
EPIC Hearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-866-956-5400
Transporte - administrado por LogistiCare

Reservaciones de LogistiCare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-866-913-2492
Transporte . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-866-913-2493
(TTY: 1-866-288-3133)
Beneficios dentales (UnitedHealthcare Dental Benefits) . . . 1-877-236-0826
Para ver una lista de proveedores, visite nuestro sitio web
en www.UHCCommunityPlan.com
EN CASO DE EMERGENCIA, MARQUE 911
Este documento contiene información importante. Llame gratis al 1-877-236-0826 (atención
al cliente local) para obtener el documento en otro idioma o tenerlo traducido oralmente.
www.UHCCommunityPlan.com