Updates from UnitedHealthcare Doc #: UHC0779c Our Advocates are - - PowerPoint PPT Presentation

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Updates from UnitedHealthcare Doc #: UHC0779c Our Advocates are - - PowerPoint PPT Presentation

Nov 05, 2023 323 likes •563 views

Updates from UnitedHealthcare Doc #: UHC0779c Our Advocates are Your Trusted Advisors UnitedHealthcare network facilities have the value-added benefit of having an Advocate assigned to them. How does your advocate help and work with you as your

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Updates from UnitedHealthcare

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Our Advocates are Your Trusted Advisors

UnitedHealthcare network facilities have the value-added benefit of having an Advocate assigned to them. How does your advocate help and work with you as your trusted advisor:

  • Leverage the UnitedHealthcare service model
  • Listen to challenges & opportunities and bring them to the appropriate

contact

  • Keep you informed about new initiatives impacting your practice
  • Help you document, report and resolve issues
  • Tap into information specific to health care reform, administrative

simplification, changing technology and other encompassing issues As a Promoter and Consultant your Advocate will:

  • Work with the appropriate resources to address and resolve concerns
  • Is the “voice of the provider” inside UnitedHealthcare
  • Gain and maintain confidence by providing objective expertise
  • Provide insight into factors that may effect your office
  • Share best practices
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Member Card Details – UnitedHealthcare Medicare & Retirement

  • As of June 2016, New Jersey UnitedHealthcare Medicare Advantage plans will no longer

require a referral for dates of service from June 1, 2016 through December 31, 2017.

  • Primary Care Physicians: If a UnitedHealthcare Medicare Advantage member in New

Jersey asks you for a specialist referral, please continue to recommend another network provider, consistent with your typical pattern of care and per contract requirements.

  • Network Specialists: Please honor appointments without requiring a confirmed referral

in our system to help avoid restricting member access to care.

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Member Card Details – UnitedHealthcare Medicare & Retirement

  • As of June 2016, New Jersey UnitedHealthcare Medicare Advantage plans will no

longer require a referral for dates of service from June 1, 2016 through December 31, 2017.

  • Primary Care Physicians: If a UnitedHealthcare Medicare Advantage member in New

Jersey asks you for a specialist referral, please continue to recommend another network provider, consistent with your typical pattern of care and per contract requirements.

  • Network Specialists: Please honor appointments without requiring a confirmed

referral in our system to help avoid restricting member access to care.

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Member Card Details – Garden State Plan

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Member Card Details – CORE Plan

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Member Card Details – NEXUS/ACO Plan

  • New for 1/1/17
  • UnitedHealthcare NexusACO includes a tiered benefit plan design
  • In ACO service areas: Tier 1 will include ACO care providers, as well as
  • ther select care providers and/or UnitedHealth Premium Care

Physicians

  • In non-ACO service areas: Tier 1 will be comprised of UnitedHealth

Premium Care Physicians and/or other select care providers

  • No tiering for Hospitals or Ancillaries. All included in TIER 1
  • Same Advance Notification and Authorization requirements as

UnitedHealthcare Commercial product

  • FAQs available

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UnitedHealthcare Oxford Navigate Individual Benefit Plans

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Navigate Background

  • Effective Jan. 1, 2017, Oxford Garden

State individual benefit plans will transition to UnitedHealthcare Oxford Navigate individual benefit plans.

  • Key product features
  • PCP lock in and specialist referral
  • Prior authorization / notification
  • Individual benefit plans offered by

UnitedHealthOne.

  • UnitedHealthOne Admin Guide

applies; not Oxford Supplement

  • UHOne Payer ID, website, contacts
  • Updates included for 2017

UnitedHealthcare Oxford Navigate Individual Plans

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Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Visit Gated Network Products > External Resources > Oxford Navigate

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Navigate Member ID Cards

10 This sample ID card is for illustration only. Actual information varies depending on payer, plan and other requirements.

Look for differences on the ID card UnitedHealthcare Oxford logo and Individual Health Plan Oxford Navigate group number UHOne Payer ID Member’s assigned PCP Navigate plan name and referral required indicator Referral reminder for members and care providers myUHOne.com/provider and phone number

Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

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Websites

With UnitedHealthcare Oxford Navigate benefit plans, providers will use different websites to perform online transactions. Go to myUHOne.com/provider for:

  • Member eligibility and benefits
  • Claims status
  • Explanations of benefits (EOBs)
  • Payment listings

Go to UnitedHealthcareOnline.com for:

  • Referral submissions and status
  • Prior authorization submission and status

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Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

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Provider Education

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Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Training

Market Led Training

  • Invites sent monthly and posted to

UHCO

  • Highlighted in welcome kit
  • Highlighted in Oct Network Bulletin

Product Socialization

  • Provider Expo
  • NJPCA Annual Conference
  • NJ HFMA Annual Conference
  • Q3 AAC
  • NJ PCP Summit (tentative)
  • NJ MGMA Payer Panel (tentative)

Invitations posted at UnitedHealthcareOnline.com > Tools & Resources > Products & Services

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Changes in Advance Notification and Prior Authorization Requirements

Effective for dates of service on or after January 1, 2017, some codes will no longer require prior authorization for many plans. Following is a list of services where prior authorization requirements will be removed for certain codes and the health plans that will be impacted:

  • UnitedHealthcare Commercial plans
  • DME/Orthotics/Prosthetics
  • Cochlear Implant
  • Enteral Supplement
  • UnitedHealthcare Community Plan
  • DME/Orthotics/Prosthetics
  • Cochlear Implant
  • Potentially Unproven
  • Bariatric Surgery
  • Enteral Supplement
  • Orthognathic Surgery
  • Home Health (all states except Texas)
  • Outpatient Therapies (PT/OT/ST/RT) (New Jersey only)

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UHC Community & State - Outpatient Injectable Chemotherapy Prior Authorization Effective January 1, 2017, UnitedHealthcare Community Plan members will require prior authorization for injectable outpatient chemotherapy drugs given for a cancer diagnosis. Prior authorization will be required for:

  • Chemotherapy injectable drugs (J9000 - J9999), Leucovorin (J0640) and

Levoleucovorin (J0641)

  • Chemotherapy injectable drugs that have a Q code
  • Chemotherapy injectable drugs that have not yet received an assigned code and

will be billed under a miscellaneous Healthcare Common Procedure Coding System (HCPCS) code

  • All outpatient injectable chemotherapy drugs started after the chemotherapy prior

authorization effective date

  • Adding a new injectable chemotherapy drug to a regimen

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Reminder: Link Overview

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What’s on Link?

  • Applications on Link include:
  • Eligibility & Benefits
  • Claims Management
  • Claims Reconsideration
  • Access other

UnitedHealthcare websites:

  • UnitedHealthcareOnline.com
  • UHCCommunityPlan.com
  • And more

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Doc#: PCA-1-003659-10102016_11012016 Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

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Link Is Evolving!

  • Beginning in September, we're introducing new apps on Link
  • The new eligibilityLink and claimsLink apps will

replace the Eligibility & Benefits, Claims Status and Claim Reconsideration functions on UnitedHealthcareOnline.com

  • The new eligibilityLink and claimsLink apps use

newer technology that enables enhanced features, as well as an easy-to-use design developed with feedback from users.

  • Helps simplify your administrative workflow with enhanced

features and a faster, easier to use interface

  • The Eligibility & Benefits, Claims Management and Claims

Reconsideration apps on Link will continue to be available into 2017.

  • Policies, guidelines, resources and other functions will

continue to be available on UnitedHealthcareOnline.com.

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Doc#: PCA-1-003659-10102016_11012016 Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

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Eligibility & Benefits App

Use the Eligibility & Benefits app to check member eligibility and review detailed benefits

  • information. You may also submit referrals,

notifications and prior authorization requests using this app. 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 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.

Doc#: PCA-1-003659-10102016_11012016 Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

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Claims Management App

With the Claims Management app, 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.

Doc#: PCA-1-003659-10102016_11012016 Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

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Claims Reconsideration App

Use the Claims Reconsideration app 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 app, it will appear as a draft that can be completed and submitted in the Claims Reconsideration app.

Doc#: PCA-1-003659-10102016_11012016 Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

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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

Doc#: PCA-1-003659-10102016_11012016 Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

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Questions

THANK YOU!