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 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 2 Doc #: UHC0779c
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. 3 Doc #: UHC0779c
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. 4 Doc #: UHC0779c
Member Card Details – Garden State Plan 5 Doc #: UHC0779c
Member Card Details – CORE Plan 6 Doc #: UHC0779c
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 other 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 7 Doc #: UHC0779c
UnitedHealthcare Oxford Navigate Individual Benefit Plans 8
Navigate Background UnitedHealthcare • Effective Jan. 1, 2017, Oxford Garden Oxford Navigate State individual benefit plans will Individual Plans 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 Visit Gated Network Products > External Resources > Oxford Navigate 9 Doc #: UHC0779c Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Navigate Member ID Cards 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 This sample ID card is for illustration only. Actual information varies depending on payer, plan and other requirements. 10 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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 11 Doc #: UHC0779c Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Provider Education 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 12 Doc #: UHC0779c Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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) 13 Doc #: UHC0779c
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 14 Doc #: UHC0779c
Reminder: Link Overview 15 Doc #: UHC0779c
What’s on Link? • Applications on Link include: Eligibility & Benefits • Claims Management • Claims Reconsideration • • Access other UnitedHealthcare websites: UnitedHealthcareOnline.com • UHCCommunityPlan.com • And more • 16 Doc #: UHC0779c Doc#: PCA-1-003659-10102016_11012016 Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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. 17 Doc #: UHC0779c Doc#: PCA-1-003659-10102016_11012016 Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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. 18 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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