UnitedHealthcare Community Plan NC: Behavioral Health Billing and Optum
The most common mistake with UnitedHealthcare Community Plan of North Carolina is treating it as one plan. Behavioral health is managed by Optum, with its own forms, phone lines, and authorization process, separate from the medical side.
Short answer
UnitedHealthcare Community Plan of North Carolina is an NC Medicaid Standard Plan, and its behavioral health is managed by United Behavioral Health, operating as Optum. Outpatient authorization requests go through Provider Express forms, and acute levels of care, including ADATCs, partial hospitalization, and inpatient, are requested by phone at 800-638-3302. As of January 1, 2025, prior authorization was temporarily removed for peer support, partial hospitalization, and SACOT while NC DHHS reviewed those policies.
Where UnitedHealthcare fits
UnitedHealthcare Community Plan of North Carolina is one of North Carolina's Standard Plans, which cover most NC Medicaid members with physical and behavioral health together. Members with significant behavioral health, substance use, I/DD, or TBI needs are served by Tailored Plans instead, so confirm the member's plan in NCTracks before assuming Standard Plan rules apply.
Behavioral health runs through Optum
United Behavioral Health, operating under the Optum brand, manages behavioral health for UnitedHealthcare Community Plan of North Carolina. Authorization requests, behavioral health provider support, and crisis support run through Optum, not the medical plan's channels.
| Request | How |
|---|---|
| Outpatient behavioral health | Community Based Behavioral Outpatient Services Request Form on Provider Express |
| Applied behavior analysis | Applied Behavior Analysis Treatment Request Form on Provider Express |
| Acute levels of care (ADATC, partial hospitalization, inpatient) | Phone, 800-638-3302, 8 a.m. to 6 p.m. ET, Monday to Friday |
As of October 2026.
The 2025 authorization pause
As of January 1, 2025, UnitedHealthcare temporarily removed prior authorization for some behavioral health services, including peer support, partial hospitalization, and substance abuse comprehensive outpatient treatment (SACOT), while North Carolina DHHS reviewed those policies. Temporary changes can end, so confirm the current status before relying on it.
Where behavioral health claims go wrong
- Behavioral health sent to the medical side. Requests or questions routed to UnitedHealthcare instead of Optum.
- Treating the pause as permanent. Services billed without authorization after a temporary removal ends.
- Member is in a Tailored Plan. Behavioral health billed to UnitedHealthcare for a Tailored Plan member.
Related: verifying NC Medicaid eligibility in NCTracks, associate-level clinician billing in NC, and the NC Medicaid behavioral health billing guide.
Sources, checked October 2026: UnitedHealthcare NC behavioral health prior authorization (January 2025); UnitedHealthcare Community Plan of NC provider home. Confirm current details on the plan's provider site.
Frequently asked questions
Who manages behavioral health for UnitedHealthcare Community Plan of NC?
United Behavioral Health, operating as Optum. Behavioral health authorizations and provider support go through Optum rather than the medical plan.
How do I request an outpatient behavioral health authorization?
With the Community Based Behavioral Outpatient Services Request Form on Provider Express. ABA uses the Applied Behavior Analysis Treatment Request Form.
How do I request partial hospitalization or inpatient authorization?
By phone at 800-638-3302, 8 a.m. to 6 p.m. ET, Monday to Friday, as of October 2026.
Does UnitedHealthcare NC require authorization for peer support?
As of January 1, 2025, prior authorization was temporarily removed for peer support, partial hospitalization, and SACOT while NC DHHS reviewed those policies. Confirm the current status before billing.
Medical and behavioral routed to the right place.
See Stable route UnitedHealthcare behavioral health work to Optum and check authorization status before each claim.
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