Administrative Changes for UnitedHealthcare Medicare Advantage Members in Texas Quick Reference Guide

PCA-1-20-02593-M&R-QRG_09152020

As of Jan. 1, 2020, some administrative processes are being managed by WellMed Medical Management, Inc. for members in certain UnitedHealthcare Medicare Advantage plans. This guide helps you understand the changes to administrative processes, including:

• Member eligibility verification • Referral requests • Prior authorization requests

• Hospital admission notifications • Claims submission

These plans are included in these administrative changes: • AARP® Medicare Advantage

o H1278-004 AARP Medicare Advantage Walgreens o H1278-005 AARP Medicare Advantage Walgreens o H1278-010 AARP Medicare Advantage Choice o H2228-023 AARP Medicare Advantage Choice o H4514-007 AARP Medicare Advantage Plan 2 o H4527-001 AARP Medicare Advantage Focus o H4527-002 AARP Medicare Advantage Focus o H4527-005 AARP Medicare Advantage Focus o H4527-013 AARP Medicare Advantage Focus o H4527-024 AARP Medicare Advantage

Focus Essential o H4527-037 AARP Medicare Advantage Plan 1

o H4527-038 AARP Medicare Advantage o H4590-010 AARP Medicare Advantage SecureHorizons o H4590-012 AARP Medicare Advantage

SecureHorizons Plan 1 o H4590-025 AARP Medicare Advantage SecureHorizons o H4590-027 AARP Medicare Advantage

SecureHorizons Essential o H4590-029 AARP Medicare Advantage

SecureHorizons Essential o H4590-041 AARP Medicare Advantage

SecureHorizons Plan 2 o H4590-043 AARP Medicare Advantage

• UnitedHealthcare Chronic Complete o H4527-039 o H4527-040 o H4527-041

o H4527-042 o H4590-03

• UnitedHealthcare Dual Complete o H4590-020 o H4590-022

o H4590-033 o H5322-026

• UnitedHealthcare Dual Complete Focus o H4527-003 o H4527-004

o H4527-006 o H4527-015

• UnitedHealthcare Group Medicare Advantage o H4590-803

There is no change to the administrative services for members of these plans: • H0710-020 UnitedHealthcare Nursing Home Plan • H1278-003 AARP® Medicare Advantage Choice • H2228-041 UnitedHealthcare Dual Complete (PPO) • H4514-001 UnitedHealthcare Dual Complete • H4590-042 AARP® Medicare Advantage • H5322-025 UnitedHealthcare Dual Complete • H5652-001 Erickson Advantage Signature with Drugs • H5652-002 Erickson Advantage Signature without Drugs

• H5652-003 Erickson Advantage Guardian • H5652-004 Erickson Advantage Champion • H5652-006 Erickson Advantage Freedom • R6801-008 UnitedHealthcare Medicare Silver • R6801-009 UnitedHealthcare Medicare Gold • R6801-011 UnitedHealthcare Dual Complete Choice • R6801-012 UnitedHealthcare Medicare Advantage Choice

If you have questions, please call us at 866-574-6088.

PCA-1-20-02593-M&R-QRG_09152020

Verifying Member Eligibility You may verify member eligibility at the time of service online, by phone or using electronic data interchange (EDI): • Online: Use the eligibilityLink tool on Link. To access eligibilityLink, sign in to Link by going to

UHCprovider.com and clicking on the Link button in the top right corner. o You can also use the care provider web portal at eprg.wellmed.net.

• By phone: Call 877-842-3210. • EDI: Use Transactions 270 (Inquiry) and 271 (Response) through your vendor or clearinghouse.

Referral Requests Submit referral requests for these members online at eprg.wellmed.net. Referral waiver: For dates of service between Jan. 1 – Dec. 31, 2020, WellMed isn’t requiring referrals for these members. There is a notification at eprg.wellmed.net to remind submitters that referrals aren’t required during this period. If you need a referral number for your records during this time, please use reference number GLEX01012020.

Prior Authorization Requests For these members, the services that require a prior authorization request will be listed in the UnitedHealthcare Medicare Advantage Prior Authorization list at UHCprovider.com/priorauth > Plan Requirements for Advance Notification/Prior Authorization. Submit your request at least 14 days before the planned date of service. • Online: Submit your request at eprg.wellmed.net. Please include any clinical information associated

with the requested service. • By phone: 877-757-4440 • By fax: 866-322-7276 You don’t need to submit another prior authorization request to WellMed if a request was previously reviewed and approved by UnitedHealthcare for dates of service starting Jan. 1, 2020 and later. WellMed will honor UnitedHealthcare approvals and reimburse for services provided to eligible members.

Hospital Admission Notifications Notify WellMed of hospital admissions no later than one business day after admission by calling

877-490-8982 or faxing 877-757-8885.

Claims Submission Submit claims for UnitedHealthcare members to WellMed using the following electronic Payer ID or mailing address: • Electronically: Payer ID WELM2 or use your clearinghouse’s WellMed payer ID • By mail: WellMed Claims, P.O. Box 400066, San Antonio, TX 78229 To check the status of your claims submission, log into eprg.wellmed.net. For any other claim questions, you can call 800-550-7691. Don’t submit duplicate claims unless you haven’t received payment or an explanation of payment within 45 days of submission.

Member ID Cards Members in the affected plans will get new member ID cards that show the payer ID WELM2 and have eprg.wellmed.net listed as the care provider contact or will have a San Antonio, TX, Medical Claims Address.

PCA-1-20-02593-M&R-QRG_09152020 © 2020 United HealthCare Services, Inc. All Rights Reserved.

Sample member ID cards for illustration only. Actual information varies depending on payer, plan and other requirements.