northern arizona provider town hall · client group. what policies does umr follow for claims...

©2017 United HealthCare Services, Inc. Proprietary information of United HealthCare Services, Inc. Do not distribute or reproduce without express permission of United HealthCare Services, Inc.

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Northern Arizona Provider Town Hall


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Agenda Welcome Remarks and

Introductions Ron Haase – Chief Human Resources Officer Northern Arizona Healthcare

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About UMR Washington Covena / Marisa Aragon – UMR

Administration things you should know Washington Covena / Marisa Aragon - UMR

04 NAH Preferred Networks I


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Presenters

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Ron Haase Chief Human Resource Officer Northern Arizona Healthcare

Dr. Robert Thompson Executive Vice President and Chief Clinical Officer Northern Arizona Healthcare

Mary Porter Benefits & HRIS Manager Northern Arizona Healthcare

Washington Covena Director of Account Management - UMR

Amy Klawitter VP of Account Management – UHC/UMR

Marisa Aragon Strategic Account Executive – UMR

Stephanie Villareal Manager Physician Contracting - UHN

Dan Benkovich Director Provider Advocacy - UHN

Connor Lynch Network Contract Manager - UHN


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UMR, a Third-Party Administrator What’s a TPA?

UMR is a TPA (Third-Party Administrator) and is hired by employer groups (Clients) to administer and process the plan benefits determined by the client group.

TPAs allow for greater flexibility with benefit administration, as well as access to a number of provider networks that fit the needs of the client. For the NAH Employee Benefit Plan we will be accessing the UHC Choice Plus Network.

UMR is an affiliate of UnitedHealthcare and is not an insurance company.


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+65 years of experience

4,200+ people focused

on your plan

3.1 million members

2,000+ customers

UMR We are the nation’s largest TPA!

Dedicated to serving hospitals

© 2014 United HealthCare Services, Inc. 6

= Client = Client hospital location


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How do medical professionals working with UMR client members access online resources?

Go to www.umr.com. On your first visit, you will need to register your TIN(s). This website is an efficient way to check claim status, obtain benefits and much more.

Please note: This is a different, secure website for UMR client member claim/benefit information. If you are already logged into www.UnitedHealthcareOnline.com, you will receive a message that the individual is a UMR plan member. The message will include a hotlink to the UMR site, where you will need to sign in. If after three tries the system cannot find the member (possibly because the person is not yet in the UMR database), you will receive a message indicating the member is not found. You should then consult the member’s ID card for directions to the correct website.


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Where to submit claims for Northern Arizona Healthcare Employee Benefit Plan?

UMR

P.O.Box 30541

Salt Lake City, UT 84130-0541

Electronic Claims should be directed to EDI #39026


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Providers, find what you need at umr.com Access your patient information in just a few clicks

At umr.com, you can view claims and benefit information, including:

• Explanations of benefits (EOBs)

• Eligibility and benefit information

• Status updates on medical deductibles

and out-of-pocket maximums

UMR has made finding claim and benefit information for your patients quick and easy


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Viewing member information After you have logged in, you can easily access member information.

From myMenu, select Claims or Benefits & coverage for the type of information you would like to view.

• Enter the member’s Social Security number or Member ID in the Member Search box and click “Go”

• Select the filter options on the left to expand or refine the claim type and your search time period.


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Need help with umr.com? Contact our technical support team at 1-866-922-8266.

Benefits > Additional benefits

Claims > Claim activity (Note: You must select a specific claim to access the Provider service center)

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Click the Provider service center displayed on the bottom of one of the following two locations:

Once you click on the link, you will receive a passcode you can use to contact us by phone and bypass the provider self-service system – connecting you

with a customer service representative.


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Getting started On umr.com

If you already have an account, go to umr.com and enter your username and password in the upper-right corner.

First time user, click New user? Register here to open an account.

Complete the online registration information.

Enter your Tax ID number and provider name.

You may view only claims associated with that Tax ID.

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Looking for a form? Here’s where to look!

• Download frequently used forms from the Forms tile on the home page.

• Need prior authorization for a procedure?

• Click Get Preauthorization from MyMenu and complete the form.

• Do not use the www.UnitedHealthcareonline site for UMR member Pre Authorization request. Use www.umr.com instead.

http://www.unitedhealthcareonline/

http://www.umr.com/


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What services will require Notification for UMR clients?

Clients with access to UnitedHealthcare Choice Plus follow the standard network requirements for Admission Notification, as well as Advanced Notification per the UnitedHealthcare Administrative Guide.

Otherwise, those services requiring prior notification or prior authorization are identified by the member’s self-funded benefit plan document. Member penalties may be applicable, for these services, as defined in the plan document for the specific client group.

What policies does UMR follow for claims processing, e.g. modifier/bundling edits?

UMR follows the same modifier/bundling edits developed by UnitedHealthcare for the Options PPO and Choice Plus products.

Please visit www.UnitedHealthcareOnline.com to review applicable medical and reimbursement policies for UHC providers.


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How to locate Coverage Determination Guidelines www.UnitedHealthonline.com


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Want to set up an electronic funds transfer (EFT) and electronic remittance advices (ERAs)?

Make paper checks and remittance advices a thing of the past with electronic funds transfer (EFT) and remittance advice (RA). Enrollment with UMR’s Payor ID (39026) is required through Optum at www.OptumHealthFinancial.com Select the Electronic funds transfer tile on the home page to get started or call the Optum EPS help desk at 1-877-620-6194.

http://www.optumhealthfinancial.com/


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Live Provider Representative

Monday – Friday 8am -5pm (PST):

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What is the customer service number for physicians, facilities and other health care professionals to call for eligibility, benefits and follow-up on claim issues? Our Interactive Voice Response (IVR) system number is:

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1-877-233-1800 Within a matter of seconds, you will receive a fax with a patient’s:

Claim status and payment detail

Benefits information

Eligibility information

Claim submission information

Deductible and out-of-pocket status

Prior authorization information

1-844-614-8433

Claim status and payment detail

Benefits information

Eligibility information

Claim submission information

Deductible and out-of-pocket status

Prior authorization information


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IVR System

Need eligibility and benefits information? Follow this simple 5-step process:

Press “1” to enter the provider self service IVR

Enter and confirm the employee’s member ID or Social Security number

Enter the patient’s date of birth

Press “1” for eligibility and benefits information

Enter and confirm your fax number

Need eligibility and benefits on multiple patients?

It’s as easy as 1, 2, 3:

After you hear “Your fax is being sent”

Press “1”

Repeat previous steps 2 through 5

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IVR System

Need claim status information? Follow this simple 7-step process:

Press “1” to enter the provider self service IVR

Enter and confirm the employee’s member ID or Social Security number

Enter the patient’s date of birth

Press “2” for claim status

Enter and confirm your 9-digit tax identification number (TIN)

Enter the date of service (MM/DD/YYYY)

Enter and confirm your fax number

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Need claim status for multiple claims? It’s as easy as 1, 2, 3:

After you hear “Your fax is being sent”

Press “1”

Repeat previous steps 2 through 7

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Can physicians complete claim reconsideration requests online?

Please Note: When contacting UMR, provide the specific issue, indicating what is expected according to the UnitedHealthcare contract. Allow up to 30 days to receive a response to the reconsideration/adjustment request. Do not allow claim reconsiderations to accumulate or to go unresolved. The contract provides for a limited period to request a reconsideration adjustment.

UnitedHealthcare provider appeals can be initiated by phone at 715-841-7415, or submitted on paper to the UMR United Provider Appeal Unit, P.O. Box 30546 Salt Lake City, UT 84130-0546

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Can customer service agents make claim adjustments over the phone?

UMR Customer First representatives (CFRs) can address claim issues over the phone, depending on the claim adjustment request. CFRs cannot change a claim, if inappropriate modifiers or CPT/HCPCS codes are listed. Such issues require a resubmission of the claim with corrected codes, from the servicing provider.

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Mobile Web

© 2014 United HealthCare Services, Inc. 21

Log in Enter your username and password for instant access to all our mobile inquiry tools.

Find a provider Need to find a doctor fast? Access an alphabetical listing of network providers.

What’s new Find out about new tools and information to help you live a healthier life.

Check your benefits View medical and/or dental benefits, as well as persons covered.

View, scan or fax your ID card View your ID card, allow your provider to scan the on-screen bar code for instant access to your benefit information, and/or fax it to a provider.

Look up claims Look up a claim for yourself or an authorized dependent.

Deductible and OOP Balances

Need help? Click the question mark any time you are confused about a term or benefit and get an explanation.

Home: Return to the main menu. Menu: Display the menu. Gear: Log out or learn more.

Simplified navigation


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Sample ID Card NAH Employee ID Cards


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NAH Employee Plan Preferred Networks www.umr.com/welcomenah

Only Available on HDHP

http://www.umr.com/welcomenah

northern arizona provider town hall · client group. what policies does umr follow for claims...

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