UnitedHealthcare of Georgia of Georgia UnitedHealthcare GASCO University Administrators’ ’ Association Association GASCO University Administrators December 3, 2008 December 3, 2008 Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
Our Mission 2 Our Mission is to help people live healthier lives � We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. � We work with health care professionals and other key partners to expand access to high quality health care so people get the care they need at an affordable price. � We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions. Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
Administrative Simplification = Provider Satisfaction and leads to Affordable Healthcare Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
Provider Advocates…Who are we? A New Partnership with Physicians A New Partnership with Physicians • UHG Navigational Specialist • • Face to Face contact • Maximize the ability to interact with UHC • Your Provider Advocate is to be your resource for issue resolution and relationship. UHG Provider Responsive, Proactive, Reliable and Simplistic! Responsive, Proactive, Reliable and Simplistic! Advocate Other Physicians Health Care Providers Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
Claim Process Flow Claim Process Flow Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
Issue Resolution Engagement Contact your Self Service via Self Service via Escalated Service Assisted Service Provider the Provider Web the United Line- from a Provider Advocate Portal Voice Portal Rapid Resolution Phone Rep. Expert Resolving claim issues Follow standard processes to submit a reconsideration of a claim (online, phone, paper.) Provider Web Portal • Allow 30 days for claim to United Voice Portal process. If you do not receive a satisfactory response within 30 days follow the steps below: First Step • Call the United Voice Portal (UVP) for resolution at 1-877-842-3210 (have your tracking number available – B plus 16 Escalated Service digits). Line- Rapid Provider Phone • If you do not receive a satisfactory Resolution Representative response within 30 days Expert Second Step • Call your Provider Advocate Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
Oncology Initiatives Initiatives Oncology Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
Oncology Line of Service A dedicated team with cancer expertise � Leader is a board certified oncologist � Address both quality of cancer care and affordability of care � Research experience to find the problems � Clinical and business skills to find solutions Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
UHC Customer Service Dedicated Call Center Team for Oncology Clinics Phone number: 1-877-842-3210 • Providers are transferred to dedicated team after entering TIN • Contractually, some ASO customer related calls must be transferred to client dedicated team Dedicated Claims Processing Team for Chemotherapy Claims • Chemotherapy claims (J 9000 claims) to be processed by specialized team. Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
Oncology Initiatives Change in UHC Herceptin Policy � Effective 01/01/2009, UHC removing the requirement to submit a pathology report to obtain coverage for Trastuzumab. Claim Submission Hematocrit Level Popup � During a Claim Submission users will now receive a Pop-up box to remind them when Hematocrit (HCT) Level is required based upon the procedure code(s) entered on the claim. KRAS Testing Required � Spring 2009, UHC is launching a KRAS requirement for coverage of Cetuximab and Pantumimab for Colorectal Cancer. Enrollees with “wild- type” KRAS gene will be eligible for coverage for Cetuximab and Pantumimab therapy. � Requirements: Submission of a pathology report documenting the type of KRAS gene. Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
State Health Benefit Plan State Health Benefit Plan Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
State Health Benefit Plan (SHBP) 12 Renewed SHBP contract effective 01/01/2009 United Healthcare administers the following State Health Benefit Plan (SHBP): � Options PPO � Choice HMO � Indemnity � High Deductible Health Plan � Definity CDHP *Important to remember: � For SHBP claim issues or benefit questions, contact the Customer Service number on the back of the member’s ID card. � UHC SHBP members have 1 single group number – 702030. � SHBP product type will be listed at the bottom of the front of the member ID card. � SHBP does not require prior notification on radiology services. Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
Standard Notification Requirements Standard Notification Requirements Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
Notification Requirements Effective December 3, 2007, Providers are responsible for Advance Notification for certain planned services. � Notification is required at least five (5) business days prior to the planned service date (unless otherwise specified within the Notification List in Administrative Guide). � Notification for home health services is required within forty-eight hours after physician's order. � If services are planned less than five (5) business days prior to the service date, notification is required as soon as the service is scheduled. Note: Physicians who have received the UnitedHealth Premium quality and efficiency of care designation are exempt from the Advance Notification requirement for certain services as indicated on the Advance Notification List. Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
Predeterminations Predeterminations Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
What is a Predetermination? • What is a predetermination? � Voluntary requests for coverage of services that may or may not be covered under the plan � Voluntary requests for coverage of services that do NOT require prior notification • How are they submitted and who submits them? � Faxed to the RMO at (801) 233-9580 � Mailed to the address on the members card � Visiting unitedhealthcareonline.com click on Claims and Payments/Claim Estimator � Providers submit clinical notes, codes and any documentation regarding why the patient needs the treatment Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
Urgent Pre-D Requests How do I escalate a Predetermination? • Fax an urgent predetermination issue to UnitedHealthcare and and email your Provider Advocate • Provider Advocate will escalate to Pred Escalate Mailbox • The Pre-D Unit will respond to the Provider Advocate stating that they received the issue and it is being worked. Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
UnitedHealthcareOnline.com UnitedHealthcareOnline.com Going Green in 2008 Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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