Transcript United Healthcare

UnitedHealthcare
2016 Education
Agenda
•
Customer Service Model
•
Communications
•
Online Member Panel Reports
•
Provider Portal / Service Model
•
Link
•
Questions
•
Contacts
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Customer Service Model
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Customer Service Model
Please follow these steps before contacting your Provider
Relations Advocate:
1. If you disagree with a claim payment decision, please do one of the following:
•Use the Claims Reconsideration application via our Provider Portal, Link. To
access Link, please sign in to UnitedHealthcareOnline.com. You can also track
and follow all your reconsiderations via Link.
•Submit a paper reconsideration.
•Call 1-877-842-3210. Be sure to obtain a tracking number for future
reference.
2. If the issue remains unresolved after 30 days, at that point please send your
Provider Relations Advocate the appropriate information: plan/product type,
member name, member ID number, date of service, billed amount and amount
expected, as well as any tracking numbers and a copy of the claim.
3. Your Provider Relations Advocate will work with Internal UHC Agents and
partners determine the cause and resolve your issue.
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Service Model Overview
Self Service via the Self Service via
the United
Provider Web Portal
Voice Portal
Assisted Service
from a Provider
Phone Rep.
Resolve issue through
Advocate
Options to contact UHC
• Access the self service options available
24 hours a day at
unitedhealthcareonline.com
Provider Web Portal
United Voice Portal
• Call the Customer Care number for selfservice information
• Call the Customer Care number to speak
with a Provider Phone representative
Obtain a tracking number for
future reference
Provider Phone
Representative
• If the provider does not obtain resolution
Advocate
of their issue to their satisfaction or 30
days have passed and there has been no
follow-up, they should call the local
Physician Advocate to resolve the issue.
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Communications
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Communications
Primary source of communication - www.UnitedHealthcareOnline.com
Administrative Guide – found under “Tools and Resources” tab
Updated annually
Includes description of plan types and sample ID cards
Find Information on Claims, Adjustments, Appeals & Notifications Requirements
Current listing of phone numbers/contact information
Network Bulletin
Published monthly ~ delivered to email
Updates and changes to policies and protocols and updates to the Administrative Guide
Coding updates and changes are communicated
Can be sorted electronically
Anyone can sign up. No limits.
Use UnitedHealthcareOnline.com/LINK to:
Verify eligibility, patient benefits and check status of claims
Submit and adjudicate claims with real time adjudication
Submit Reconsiderations and Appeals and upload documentation
Submit notifications and verify status of these
Check for authorization requirements and request
Update Practice information/demographics
Learn about UnitedHealthcare products and services
Access reimbursement and medical policies
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Network Bulletin
The Network Bulletin is a monthly publication featuring important
protocol and policy changes, as well as useful administrative
information and clinical resources for providers, practice managers,
facilities and hospitals.
Receive the UnitedHealthcare Network Bulletin via email, sign up:
https://www.unitedhealthcareonline.com/b2c/CmaAction.do?cha
nnelId=efb74ccb4726b010VgnVCM100000c520720a____
Also for our Hospitals we have a monthly Eblast that we also send
out. If you are interested please sign up at our table.
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Online Member Panel Reports
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Member Panel Reports
Providers can now view Reports specific to UnitedHealthcare
Medicare Plans.
Sign In to UnitedHealthcareOnline.com
2. Select the UnitedHealthcare Online application on Link
3. Select Reports from the Tools & Resources
Select the UnitedHealthcare Online application on Link
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Member Panel Reports cont.
Select Reports from the Tools & Resources
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Member Panel Reports cont.
From the Report Search page, select the Report Type from the pull-down
menu.
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Member Panel Reports cont.
Select the report to wish to run. You may choose from several selections.
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Member Panel Reports cont.
After selecting the Report Type you want, complete the required
information and click on Search.
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Member Panel Reports cont.
Click on the available report you want to view.
For complete instructions, please refer to
your Quick Reference Guide handout:
‘Tools & Resources
Reports
QUICK REFERENCE’
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Provider Portal - LINK
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Provider Portal
UnitedHealthcareOnline.com has a new look and feel…we listened to our providers
and tailored our provider portal based on their feedback
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Ease of Access
Follow the News:
Access to Network Bulletins, Medical Policy Updates, Alerts to Systems Outages, Weather Alerts, etc.
Quick Links:
Link, Trainings, Policies, Protocols and Administrative Guides, ICD-10, EPS and much more.
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Link Overview
• Link is your gateway to UnitedHealthcare's online tools.
• It replaced Optum Cloud Dashboard. Link includes many of the same
applications as Optum Cloud Dashboard, but with a new interface that
can help make your work measurably faster and easier.*
• Use Link to check member eligibility and benefits, manage claims and
submit claim reconsideration requests.
• With Link, you can quickly move between UnitedHealthcare
applications and websites, and even customize your screen to put your
most common tasks just one click away.
• Later this year, we’ll introduce enhanced applications and additional
features to help make your transactions with us even faster.
* Based on ongoing usability studies using keystroke-level modeling when comparing Link to
UnitedHealthcareOnline.com and Optum Cloud Dashboard.
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Sign into UnitedHealthcareOnline.com
to Access Link
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Use Your Optum ID
If you can’t remember your Optum ID or
password, click on Sign In, then Forgot
Username or Forgot Password.
If you don’t have an Optum ID yet, please
register for one by clicking Register Now.
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Link Home Page
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Moving Link Application Tiles
You can rearrange the position of the application tiles
by clicking on “Edit” in the upper right of the Link
home page.
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Moving Link Application Tiles
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What’s on Link?
Applications on Link include:
• Eligibility & Benefits
• Claims Management
• Claims Reconsideration
Access other UnitedHealthcare
websites:
• UnitedHealthcareOnline.com
• UHCWest.com
• UHCCommunityPlan.com
• And more
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Eligibility & Benefits Application
Use the Eligibility & Benefits application to check member
eligibility and review detailed benefits information. You may
also submit referrals, notifications and prior authorization
requests using this application.
Features include:
• Search for covered members.
• View prior authorization/advance notification requirements, cost share
amounts and benefit coverage details.
• Submit and check status of referrals.
• View preventive care opportunities information for UnitedHealthcare
Medicare Solutions and UnitedHealthcare Community Plan members.
• View detailed benefits information for multiple plans.
• See coverage details and limits specific to each benefit plan.
• Export or print data.
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Claims Management Application
With the Claims Management application, you can get the
most up-to-date claims status and payment information
quickly and conveniently. Claims processed within the last
two years are available.
Features include:
• Search for claim submissions and access claim summaries and details
for multiple UnitedHealthcare plans in a single application.
• View payment information, remark codes and their descriptions.
• Submit additional information requested on pended claims.
• Submit appeals (only available in certain states).
• View Explanations of Benefits (EOBs) and letters for UnitedHealthcare
Commercial benefit plans.
• Select a claim for reconsideration.
• Flag claims for future viewing.
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Claims Reconsideration Application
Use the Claims Reconsideration application to quickly look
up processed claims and submit paid or denied claims as
reconsiderations with or without attachments. You will
receive a ticket number and can check the status of your
submission online.
Features include:
• Search for paid or denied claims.
• Receive instant printable confirmation of completed claim
reconsideration requests.
• Search for a claim reconsideration request to check its status or view its
history.
• Update previously submitted reconsideration requests.
• If you selected a claim for reconsideration in the Claims Management
application, it will appear as a draft that can be completed and
submitted in the Claims Reconsideration application.
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Link Resources
To learn more about Link, please visit the Link resources page at
UnitedHealthcareOnline.com > Quick Links > Link: Learn More.
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Medicare Advantage ReferralRequired Plans
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Medicare Advantage ReferralRequired Plans
Comprehensive, member-centered health care
Medicare Advantage plans
combine Medicare Parts A and
B and Part D into a single plan
that features:
• Selection of primary care
provider (PCP) who helps the
member manage their care
• Referrals to network
specialist physicians
• Typically lower costs than
original Medicare
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Primary Care Physician Role
PCPs can help guide members
through a complex health care system
Each member selects a PCP when
they enroll.
The PCP must be within the market
area of the member’s permanent
residence
If a member does not select a PCP,
UnitedHealthcare will assign one.
Members can elect to change their
PCP at any time.
Visit UnitedHealthcareOnline.com > Tools & Resources > Products & Services > Medicare for a full list of referral-required plans.
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Benefits and Programs
Key Benefits May Include:
•
•
•
•
•
Annual routine physical exam
Routine hearing and vision services
Preventive dental services
Medicare Part D prescription drug coverage
$0 copay for a 90-day supply of Tier 1 and 2
medications with home delivery
• $0 annual medical deductible
Additional Programs and Services
•
•
•
•
Advocate4me
24-hour NurseLineSM
HouseCalls
Fitness, wellness, voluntary disease
management and caregiver support
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Sample Member ID Card
This sample ID card is for illustration only. Actual information varies depending on payer, plan and other requirements
.
The member ID card can be viewed online using the Eligibility & Benefits application on Link.
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UnitedHealth Passport
Helping members use UnitedHealth Passport
1. Verify member eligibility for
UnitedHealth Passport
•
•
Check the member ID card for the
Passport logo
Call Provider Services to check
Passport eligibility
2. Confirm the member has
activated UnitedHealth Passport
•
•
Ask the member
Call Provider Services
3. Verify your participation with
UnitedHealth Passport
Note: Prior notification/ authorization protocols apply.
Referral-required plan members do not need referrals
when using services under Passport.
Visit UnitedHealthcareOnline.com > Tools & Resources > Medicare > HMO, POS, PPO for more information.
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Referral Requirements
PCPs send
UnitedHealthcare
electronic referrals.
PCP
Specialists maintain
contact with PCPs
to coordinate care
and make
recommendations.
Each specialist
with a different
TIN must have a
separate referral.
Specialist 1
Specialist 2
To learn more about referrals, go to
UnitedHealthcareOnline.com > Help > Tutorials
> Notifications/Prior
Authorizations
> Referral
To learn more about
referrals, go to
UnitedHealthcareOnline.com
> Help
Submission & Status Tutorial.
> Tutorials > Notifications/Prior Authorizations > Referral Submission &
Status Tutorial.
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Referral Exclusions
Eligible Services that Do Not Require a Referral
• Any service provided by a network PCP or a network physician
practicing under the same tax ID number as the member’s PCP
•
Any service from a network obstetrician/gynecologist, chiropractor,
audiologist, oncologist, nutritionist, podiatrist, optometrist,
ophthalmologist, optician, disease management or infectious disease
specialist
•
Services performed in an observation setting
•
Allergy immunotherapy
•
Mental health/substance use services with behavioral health clinicians
•
Any service from a pathologist or anesthesiologist (excludes officebased or pain management services), or from any inpatient consulting
physicians including hospitalists
•
Services rendered in an emergency room, emergency ambulance,
network urgent care center, convenience clinic or virtual visit
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Referral Exclusions cont.
• Medicare-covered preventive services, kidney
•
•
•
•
•
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disease education or diabetes self-management
training
Routine annual physical exams, vision or hearing
exams
Any laboratory and radiological testing services,
excluding radiation therapy
Durable medical equipment, home health,
prosthetic/orthotic devices, medical supplies,
diabetic testing supplies and Medicare Part B
drugs
Additional items that may be covered by some
Medicare Advantage plans but are not covered by
Medicare, such as hearing aids, routine eyewear,
fitness benefits such as a gym membership, or
outpatient prescription drugs
Services obtained under the UnitedHealth
Passport program
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Prior Authorizations and
Notifications
• Standard prior authorization and
notification protocols apply
• Certain planned services require prior
authorization, as outlined in the
Administrative Guide. This includes
cardiology and radiology notifications.
• Compliance with protocols related to
inpatient admission notification are
the responsibility of the hospital.
• Services that require prior
authorization and notification may
also require a referral to the specialist
performing the service.
• The ordering/rendering physician is
responsible for obtaining prior
authorizations.
To learn more about prior authorizations and notifications,
go to UnitedHealthcareOnline.com > Clinical Resources,
Advance and Admission Notification Requirements
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Additional Resources
For more information about UnitedHealthcare
Medicare Advantage plans, go to
UnitedHealthcareOnline.com > Tools &
Resources > Products and Services >
Medicare
Here you can find:
• Quick reference guides
• Frequently asked questions
• Medicare Referral-Required Plans
For general product questions, contact
Provider Services at 877-842-3210.
Visit UnitedHealthcareOnline.com > Tools & Resources > Medicare for a full list of referral-required plans.
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Medicare Advantage Referral-Required
Plans in Massachusetts
State
Massachusetts
Covered
Counties
Name
Bristol, Essex,
AARP® MedicareComplete® Plan 1
Hampden,
AARP® MedicareComplete® Plan 2
Middlesex,
AARP® MedicareComplete® Plan 3
Plymouth, Suffolk
New for 2017:
Worcester
Plan
CMS
Type Contract
HMO
H1944-001
H1944-004
H1944-005
H1944-006
H1944-007
H1944-008
H1944-021
H1944-022
H1944-023
Visit UnitedHealthcareOnline.com > Tools & Resources > Medicare for a full list of referral-required plans.
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Medicare Advantage ReferralRequired Plans
• Training Sessions: Sign up on line
uhc.webex.com.
• THURSDAY, DEC. 15, 2016 10 A.M.
EASTERN TIME Enter Session 821 960 281
and Password uhc
• If you have questions, please contact
Michelle Haryasz
[email protected] or 952-202-6090
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Questions
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Important Contact Information
Provider Service Team:
Elizabeth Connor, Sr Provider Relations Facility Advocate
[email protected]
Michelle Haryasz, Sr Provider Relations Physician Advocate
[email protected]
Valbona Lamaj, Provider Relations Physician Advocate
[email protected]
Pamela Connolly, Manager Provider Relations Advocacy
[email protected]
Alexandra Shephard-Rowe, Associate Director Hospital Advocacy,
New England
[email protected]
Jim Dubreuil, VP Provider Service, New England
[email protected]
United Provider Service (877) 842-3210
[email protected]
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