2015 payer seminar presented by maya bell-hubbard – physician advocate

2015 Payer Seminar Presented by Maya Bell-Hubbard – Physician Advocate

Agenda

• UnitedHealthcare Community Plan of Ohio

• All Savers

• Navigate

• Compass

• MyCare Ohio – UnitedHealthcare Connected

• AARP Medicare Solutions

• Standard Service Model Process

• How to Contact Us

• Questions

2PCA12915_20140618 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

UnitedHealthcare Community Plan: Covered Families and Children (CFC)

UnitedHealthcare Community Plan is a Medicaid Managed Care plan for members covered by Medicaid plans, including Healthy Start and Healthy Families. It provides Medicaid benefits plus:

• No copayments

• Rewards for keeping pregnancy-related and HealthChek appointments

• Annual eye exam

• Soft contacts or eyeglasses yearly

• Preventative dental exams and cleanings every six months.

• Transportation to health appointments and for Medicaid redetermination (30 one-way or 15 round-trips per year)


UnitedHealthcare Community Plan: Aged, Blind and Disabled (ABD) Plus

ABD Plus provides Medicaid benefits plus:

• No copayments

• Rewards for keeping scheduled appointments

• Annual eye exam

• Soft contacts or eyeglasses yearly

• Transportation to health appointments and Medicaid redetermination (30 one-way or 15 round-trips per year)

• Preventative dental exams and cleanings every six months


UnitedHealthcare Community Plan: Member Eligibility

• Check eligibility, primary care provider (PCP) and coordination of benefits details at: UnitedHealthcareOnline.com > Patient Eligibility & Benefits > Patient Eligibility > Patient Search

• View PCP panel report at: UnitedHealthcareOnline.com > Tools & Resources > Reports > Panel Report


http://www.unitedhealthcareonline.com/


UnitedHealthcare Community Plan: Member ID Cards

Members receive a new member ID card with a new member ID number.

Sample of new member ID card for ABD:


All Saver

All Savers Insurance Company (ASIC), administered by UnitedHealthcare Services, Inc., offers health plans built for small businesses. These plans can include built-in credit in the form of first dollar coverage to help employees pay for their everyday health care expenses before they meet their deductible.

• The All Savers plans are now being offered to employers in your area.

• Members with All Savers plans have access to the UnitedHealthcare Choice Plus network with the exception of Mayo Clinic facilities.

• No separate dental or vision plans are available.

• PCP GateKeeper referals required


All Savers Contacts

Paper Claims Address

UnitedHealthcare - All Savers Plans

P.O. Box 31375

Salt Lake City, UT 84131-0375

Claims Reconsiderations

Customer Service 800-291-2634

Formal Appeals Address

United HealthCare Services, Inc.

Appeals Review P.O. 31371 Salt Lake City, Utah, 84131-0371


All Saver Member Card


Navigate UnitedHealthcare Navigate is a portfolio of benefit plans that

emphasizes the role

of the primary care physician. The Navigate benefit plan portfolio became available on

January 1, 2012 in the state of Ohio.

• Primary Care Physician Requirement – Navigate members are required to choose an in-network primary care physician in order to receive the highest level of benefits. Physicians who are part of a leased network cannot be selected as primary care physicians.

• Referrals to Network Specialists – The member’s primary care physician generates referrals to network specialists.


Navigate Member Card


Compass

UnitedHealthcare Compass offers members access to a network of care providers customized according to market needs and resources. A primary care physician (PCP) coordinates member care, focusing on specific patient needs and driving personalized care improvements. Compass includes Individual Exchange Benefit Plans and any required off Exchange versions of such plans in certain markets where we act as a Qualified Health Plan Issuer. To identify Compass network service areas, go to UnitedHealthcareOnline.com > Tools & Resources > Products & Services > UnitedHealthcare Compass.


Compass Member Card


Counties•Columbiana

•Cuyahoga

•Geauga

•Lake

•Lorain

•Mahoning

•Medina

•Portage

•Stark

•Summit

•Trumbull

•Wayne

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MyCare Ohio – UnitedHealthcare Connected: Service Area

PCA12915_20140618 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Eligibility:Members older than 18 who receive Medicare Parts A, B & D and Medicaid benefits and live in one of the seven multi-county demonstration regions

•Members with disabilities

•Members who receive behavioral health services

Options: At least two managed care plans in each region for Medicare and Medicaid benefits

Medicare Opt Out:May have managed care plan provide Medicare benefits or opt out of Medicare portion and stay with current Medicare Advantage plan or traditional Medicare

Enrollment Period:Phased by region since May 1, 2014

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MyCare Ohio – UnitedHealthcare Connected: Eligibility and Options


Physician Services: 800-600-9007

Prior Authorization: 800-366-7304

Care Management: 800-508-2581

UnitedHealthcare National Credentialing Center: 877-842-3210

OptumRx Pharmacist: 877-889-6510

OptumRx Prior Authorization/Exception Review: 800-711-4555

Behavioral Health Provider Information: 877-614-0484

Member Services: 877-542-9236; TTY 711, Monday-Friday 7 a.m. to 8 p.m. EST

NurseLineSM: 800-542-8630; TTY 800-855-2880; 24 hours a day, 7 days a week

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MyCare Ohio – UnitedHealthcare Connected: Contacts


UHCConnected.com/OHIO

Medical Claims: P.O. Box 8207, Kingston, NY 12402-8207

Medical Claim Disputes: UnitedHealthcare Community Plan of Ohio, P.O. Box 31364, Salt Lake City, UT 84131-0364

Pharmacy Claims: OptumRx, P.O. BOX 29045, Hot Springs, AR 71903

Medicaid Managed Plan Part D Appeals:P.O. Box 6103, Cypress, CA 90603-8235 Fax: 877-960-8235

Member Eligibility, Claim Status and Reference Materials:UnitedHealthcareOnline.com > Tools and Resources > UnitedHealthcare Community Plan Resources

Credentialing: UnitedHealthcare National Credentialing Center: 877-842-3210

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MyCare Ohio – UnitedHealthcare Connected: Contacts (cont’d.)


http://www.uhcconnected.com/OHIO


Dual Special Needs Plans: Separate Medicare and Medicaid Cards

MyCareOhio – UnitedHealthcare Connected

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MyCare Ohio – UnitedHealthcare Connected: Sample Member ID Cards

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MyCare Ohio – UnitedHealthcare Connected: Sample Member ID Cards


UnitedHealthcare Medicare Solutions

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UnitedHealthcare Medicare Solutions Collaboration with your practice to maximize member outcomes

• Focus on quality measures, e.g., gap closures

• Meet monthly with practice to review Patient Care Opportunity Reports (PCOR)

• Navigating administrative tools and resources available through UnitedHealthcare

• HQPAF ownership (initial introduction and review, deployment/training, monitoring status and assist with submission)

• RAF documentation and coding training

• Clinical & coding education available

• Assist with appointment scheduling & follow up

• Educational and informational support of members between appointments

• Care management of members with complex health issues

• Potential Gap In Care highlight or flag in EMR, where available

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

Provider Resources Available to Primary Care Practices that qualify for provider incentives to help you reach your incentive goals

UnitedHealthcare Medicare SolutionsAARP® MedicareComplete®

22Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

AARP® MedicareComplete® members have access to:

•HouseCalls: in-home health care practitioner visit.•Pharmacy Saver™: program for low-cost prescription drugs through participating network pharmacies•MyAARPMedicare.com: member website•NurseLineSM: 24-hour nursing consultation service•My Advocate®: outreach and advocacy for social service•Renew: personalized online health resource•Member Perks™

: discounts on health-related products

23Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Benefit highlights

•Affordable premiums and copays•Annual medical out-of-pocket maximum•Skilled nursing facility care with no hospital stay requirement•Behavioral health services to help manage stress, quit an unhealthy habit or deal with loss with affordable copays•Hearing Aids with hiHealthInnovations with affordable copays•Fitness benefit with SilverSneakers•UnitedHealth Passport® travel healthcare benefit•Referrals to specialist may be required

UnitedHealthcare Medicare SolutionsAARP® MedicareComplete®

Standard Service Model

Step 1


• Self-service available at www.unitedhealthcareonline.com

• Self-service via the United Voice Portal (our interactive voice response (IVR) system) at 877-842-3210

• Assisted service from your dedicated group of Provider Phone Representatives


Step 2

1. Electronic Claim Reconsideration Request on Optum Cloud Dashboard (preferred method) By using this method, you can:

• Submit requests with or without attachments.

• Reduce the overall turnaround time for the request.

• Receive immediate confirmation and a unique tracking number to show we received your request.

• Check submission status throughout the process.


Step 3

If step 1 and 2 have failed please contact your Provider Advocate Representive. If you need help identifying your Advocate please see todays speaker.


• To check eligibility, claim status and access reference material, go to UnitedHealthcareOnline.com > Tools & Resources.

• For customer service for all plans, call 800-600-9007.

• For demographic, fee schedule or contract questions, contact your Network Manager.

• For credentialing, call 877-842-3210, enter your Tax ID number, then select other professional services, then credentialing.

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How to Contact Us



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Questions?

Thank you!


2015 payer seminar presented by maya bell-hubbard – physician advocate

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