2020 Medicare Advantage Plan Overview Indiana...Health Maintenance Organization (HMO) – ... switch...

2020 Medicare Advantage Plan Overview Indiana Care Provider Education Session

[DATE]

Welcome • UnitedHealthcare’s Mission

• Medicare Advantage Plan Types

• What’s New for 2020

• Getting Ready for Medicare’s Annual Enrollment Period

• Available 2020 Indiana Plans

• Recognizing Our Plans

• Doing Business with Us

OUR MISSION

To help people live healthier lives and to help the health care system

work better for everyone.

UnitedHealthcare Medicare Advantage Plan Types

4 © 2020 United HealthCare Services, Inc. All rights reserved. PCA-1-20-00217-M&R-PRES_01222020

• Health Maintenance Organization (HMO) – A defined network of contracted local physicians and facilities to provide care.

• Point of Service (HMO-POS) – Includes all the features of an HMO plus the ability to go outside the

contracted network for certain health care services – typically at a higher cost. POS plans do not need referrals for specialty care.

• Preferred Provider Organization (PPO) – Offers members access to a network of contracted

physicians and facilities, but also allows them the flexibility to seek covered services from outside of the contracted network – usually at a higher cost. Members do not need a referral for specialty care.

• PPO plans are available as either local PPO (LPPO) – certain counties within a state – or regional PPO (RPPO) offerings. RPPOs serve a larger geographic area – either a single state or a multi- state area. RPPOs offer the same premiums, benefits and cost-sharing requirements to all members in the region.

• Private Fee-for-Service (PFFS) – Allows members the option to seek care from any Medicare-eligible

care provider without a referral – as long as the care provider agrees to the plan's terms, conditions and payment rates.

• Includes a wide variety of health care benefits – often at a lower cost than Original Medicare.

Getting Ready for the Annual Enrollment Period

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What is the Annual Enrollment Period (AEP)? During Medicare’s AEP, which runs from Oct. 15 – Dec. 7 each year, Medicare-eligible enrollees can enroll, switch or drop a Medicare Advantage plan or prescription drug plan for the upcoming calendar year.

What does AEP mean for care providers and staff? During AEP, eligible enrollees may turn to their care providers to help them determine the right plan.

What information is available? UnitedHealthcare plan information is available at UHCprovider.com/plans > Choose Your State > Medicare > Select Plan Name.

More information on Medicare’s AEP is at medicaremadeclear.com.

© 2020 United HealthCare Services, Inc. All rights reserved. PCA-1-20-00217-M&R-PRES_01222020

What’s New – Plan Name Changes

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• For 2020, we are changing UnitedHealthcare and AARP® Medicare Advantage plan names from MedicareComplete® to Medicare Advantage.

2019 Example Plan Name

AARP® MedicareComplete

UnitedHealthcare MedicareComplete

2020 Example Plan Name

AARP® Medicare Advantage

UnitedHealthcare Medicare Advantage


What’s New – AARP® Logo Enhancements


UnitedHealthcare Medicare National Network (PPO)

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• Beginning Jan. 1, 2020, many but not all, UnitedHealthcare- and AARP®-branded PPO plan members will have access to a broader national network of contracted care providers. That means these PPO members will have nationwide access to care at in-network costs using our Medicare national network.

• Care providers already contracted with UnitedHealthcare are automatically included in the national network and would be able to start seeing members in 2020.

• The member’s ID will confirm if the member’s plan includes national network access. • PPO members who have access to the national network would no longer need to activate Passport to

access care outside their local service area. • Only members of participating PPO plans in the following states can access the national network of

care providers: • Arizona • Arkansas • Colorado • Connecticut • Florida • Georgia • Idaho • Illinois • Indiana

• Iowa • Kansas • Kentucky • Massachusetts • Maine • Minnesota • Missouri • Nebraska • New Mexico

• North Dakota • North Carolina • New Hampshire • New York • Ohio • Oklahoma • Oregon • Pennsylvania • Rhode Island

• South Carolina • South Dakota • Tennessee • Texas • Utah • Vermont • Wisconsin • Virginia • West Virginia

Network size varies by market and exclusions may apply.


UnitedHealthcare Medicare National Network (PPO)

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

Members will no longer need to activate Passport to access care outside their local service area for PPO plans.


Medicare Advantage Plans in Indiana

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Indiana Market Overview

AARP® Medicare Advantage Profile/Parkview (HMO-POS)

AARP® Medicare Advantage Plan 1 (HMO-POS)


AARP® Medicare Advantage Focus/Lutheran (PPO)

5 AARP® Medicare Advantage Choice (PPO)

AARP® Medicare Advantage Choice Plan 1 (PPO)


AARP® Medicare Advantage/WellMed (PPO & HMO-POS)

UnitedHealthcare Dual Complete®

(PPO SNP)

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In Indiana, we offer the following Medicare Advantage plans:


Medicare Advantage Plans

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Plan Name Plan ID Group Numbers Service Area/Counties

UnitedHealthcare Dual Complete® (PPO SNP)

H0271-005 67200 All Indiana Counties except for Wayne County

AARP® Medicare Advantage Profile (HMO-POS) Parkview

H2802-007 00700, 00701 00746 ,00747

Allen, De Kalb, Huntington, Lagrange, Noble, Whitley


H2802-008 00702, 00703 00748, 00749

Adams, Wells


H2802-010 00704, 00705 00744 ,00745

Bartholomew, Benton, Blackford, Boone, Brown, Carroll, Clinton, Decatur, Delaware, Fayette, Fountain, Hamilton, Hancock, Hendricks, Henry, Howard, Jay, Johnson, Lawrence, Madison, Marion, Monroe, Montgomery, Morgan, Orange, Putnam, Randolph, Rush, Shelby, Tippecanoe, Tipton, Union, Warren, White


H2802-012 00709, 00710 00750, 00751

Crawford, Daviess, Dubois, Gibson, Knox, Martin, Perry, Pike, Posey, Spencer, Vanderburgh, Warrick


H2802-015 00714, 00739 00754

Cass, Elkhart, Fulton, Grant, Kosciusko, Marshall, Miami, St. Joseph, Steuben, Wabash


H2802-016 00740, 00755 00756

Clark, Dearborn, Floyd, Franklin, Harrison, Jackson, Jefferson, Jennings, Ohio, Ripley, Scott, Switzerland, Washington


H2802-018 00742, 00743 00758, 00759

Jasper, La Porte, Lake, Newton, Porter, Pulaski, Starke


H2802-020 00721, 00722 00761, 00762

Clay, Greene, Owen, Parke, Sullivan, Vermillion, Vigo


Medicare Advantage Plans

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Plan Name Plan ID Group Numbers Service Area/Counties


H2228-019 67001, 67021 67030, 67031

Allen, De Kalb, Huntington, Lagrange, Noble, Whitley

AARP® Medicare Advantage Focus (PPO) Lutheran

H2228-020 67007, 74000 67032, 74001

Adams, Allen, Huntington, Wells, Whitley


H2228-021 67025, 67024 67194, 67195 67026, 67027 67028, 67029

Bartholomew, Benton, Blackford, Boone, Brown, Carroll, Clinton, Decatur, Delaware, Fayette, Fountain, Hamilton, Hancock, Hendricks, Henry, Howard, Johnson, Lawrence, Madison, Marion, Monroe, Montgomery, Morgan, Orange, Putnam, Randolph, Rush, Shelby, Tippecanoe, Tipton, Union, Warren, White

AARP® Medicare Advantage Choice (PPO)

H2228-022 67017, 67034 Crawford, Daviess, Dubois, Gibson, Knox, Martin, Perry, Pike, Posey, Spencer, Vanderburgh, Warrick


H2228-064 67171, 67172 90101, 90102

Jasper, La Porte, Lake, Newton, Porter, Pulaski, Starke

AARP® Medicare Advantage Choice (PPO) H2228-065

67173, 67174 90103, 90104

Clark, Dearborn, Floyd, Franklin, Harrison, Jackson, Jefferson, Jennings, Ohio, Ripley, Scott, Switzerland, Washington


H2228-066 67175, 67176 90105, 90106

Clay, Greene, Owen, Parke, Sullivan, Vermillion, Vigo


H2228-080 74055,90126 Adams, Allen, De Kalb, Elkhart, Huntington, St. Joseph, Wells, Whitley


H2228-081 74056, 74057 90127, 90128

Boone, Hancock, Hamilton, Hendricks, Johnson, Marion


Indiana Plan Specifics


Recognizing Our Plans

UnitedHealthcare Medicare Advantage ID Cards

Plan Name Type

PCP Name and Phone Number

Copay Information

HMO – POS


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Medicare Contract Number

PPO



WellMed


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National PPO



DSNP


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Members no longer need to activate Passport to access care outside their local service area for PPO plans. Activation is needed for HMO plans only.


Doing Business with Us

Claims Submission

Electronic Submission

Payer ID 87726*

• You can submit claims using the claimsLink tool on Link.

• You can also use the clearinghouse of your choice.

• If you receive an 835 Electronic Remittance Advice (ERA) through a vendor, please ask them to enroll you for the 835 through OptumInsight.

• To find out more, please contact your vendor or call Electronic Data Interchange (EDI) at 800-842-1109.

• For WellMed Payer ID, WELM2, reference member ID card for details.

Paper Submission Mail Claims to:

Address outlined on the back of each member’s ID card.

Standard Timely Filing: • 90 days from the date of service or the time

frame in your participation agreement.

Claim Resubmission

• Preferred Method: Submit electronically through your EDI clearinghouse or use the claimsLink tool on Link.

• When resubmitting through claimsLink, choose “Resubmission of a correct claim.”

• You can include attachments, such as invoices.

• You’ll receive a confirmation number – save this number for future reference.


Signing Up for Electronic Payments & Statements

With Electronic Payments & Statements (EPS), you receive electronic funds transfers (EFT) for claim payments and an online Explanation of Benefits (EOBs).

• EPS lessens administrative costs and simplifies bookkeeping.

• Reimbursement turnaround time is faster.

• Funds are available as soon as they are posted to your bank account.

To enroll in EPS today, visit myservices.optumhealthpaymentservices.com.

Here’s what you’ll need:

• Bank account information for direct deposit

• Either a voided check or a bank letter to verify bank account information

• A copy of your practice’s W-9 form

For more information, please call 877-620-6194.

UHCprovider.com/eps


Online Resources: UHCprovider.com

Resources specifically for Medicare Advantage plans can be found at UHCprovider.com/plans > Choose Your State > Medicare.

Register at UHCprovider.com/newuser to use Link, your gateway to

UnitedHealthcare’s online tools.

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Find administrative guides, policies and protocols.

Access the most- used transactions and information.


eligibilityLink: Benefits and eligibility information

claimsLink: Claim status and payment determination/remediation

Electronic Payments and Statements: Receive EFTs for claim payments and an online EOB

Document Vault: Contains commercial claim letters

Paperless Delivery Options: Turn off paper letters

Prior Authorization and Notification: Prior authorization determination and submission

PreCheck MyScript: Run a pharmacy trial claim and get real-time prescription coverage details for your patients

Access Link through UHCprovider.com/link. If you have questions, please call the UnitedHealthcare Connectivity Help Desk at 866-842-3278, option 1, 7 a.m. to 9 p.m. Central Time, Monday through Friday.

Online Resources: Link


How We Communicate with You

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• UHCprovider.com has a variety of resources that include:

- Care Provider Administrative Guide at UHCprovider.com/guides

- Practice Matters newsletter

- Network Bulletin newsletter

- Provider alerts and reimbursement policy updates

- Medicare Advantage plan summaries by state


Indiana Provider Advocates and Network Management

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• Your Provider Advocate is an important resource when you have questions. They are your single point of contact across all UnitedHealthcare’s benefit plans to help make your interactions with us easier and more efficient.

• If you have questions, please contact your Provider Advocate at [email protected] or

Network Management at [email protected].

• If you don’t know your dedicated Provider Advocate, please contact Provider Relations at

UHCprovider.com > Menu > Contact Us > Find a Network Contact > Indiana.


mailto:[email protected]

mailto:[email protected]

Thank you.

Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a Medicare-approved Part D sponsor. Enrollment in these plans depends on the plan's contract renewal with Medicare. UnitedHealthcare Insurance Company pays royalty fees to AARP® for the use of its intellectual property. These fees are used for the general purposes of AARP.® AARP® and its affiliates are not insurers. You do not need to be an AARP® member to enroll. AARP® encourages you to consider your needs when selecting products and does not make specific product recommendations for individuals. PCA-1-20-00217-M&R-PRES_01222020 © 2020 United HealthCare Services, Inc.

2020 Medicare Advantage Plan Overview Indiana...Health Maintenance Organization (HMO) – ... switch...

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