Provider Relations September 2014. 2 Confidential Property of UnitedHealth Group. Do not distribute...
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Transcript of Provider Relations September 2014. 2 Confidential Property of UnitedHealth Group. Do not distribute...
Provider Relations
September 2014
2Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Agenda
• Physician Advocates & Network Management• Reconsideration versus Appeal• Notifications/Prior Authorizations• Optum Cloud• ICD-10• Updates• Contact Information• Questions
3
Advocates &Network Management
4
What is a Physician Advocate?
A UnitedHealthcare navigational specialist
Product expert, represents all
Externally focused – interacts with the physicians and has a direct line
of sight to the challenges experienced by local practices.
Relationship manager – builds collaborative working relationships
and communicates changes to physicians in a timely way
United Healthcare
Physician Advocate
PhysiciansOffice Staff
Responsive, Proactive, Reliable and Simplistic!
5
Network Account Management
Your Partner for Contract Needs
To find your Network Account Manager
www.unitedhealthcareonline.com > Contact Us > Select “Nebraska”
Contract negotiations and management
Contract interpretation questions
Fee schedule inquiries
Product offerings and amendments
6
Reconsiderations versus Formal Appeals
7Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Reconsideration vs. Appeal
Step 1: Claim ReconsiderationStep 2: Claim Appeal
8
Prior Authorization/Notifications
9Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Notifications/Prior Authorizations
• Referral Submission• Referral Status• Notification/Prior Authorization Required
Inquiry• Notification/Prior Authorization Status• Notification/Prior Authorization Submission• Radiology Notification & Authorization
• Submission & Status• Radiology Notification
• Submission & Status• OptumRx Prior Authorization
• Submission & Status• Specialty Drug Prior Authorization
• Submission & Status• Cardiology Notification & Authorization
• Submission & Status
10Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Optum Cloud Resources
1111Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
The Next Evolution of our online tools is here. Join us on the Optum Cloud Dashboard
Optum Cloud Dashboard is a cloud-based* website where UnitedHealthcare will add new features and functionality for physicians and health care professionals.
NOW AVAILABLE: The Claim Reconsideration with Attachments application (app) is available for these lines of business: UnitedHealthcare Commercial, Medicare Solutions, Oxford, UnitedHealthcare West, and UnitedHealthcare Community Plan**. Please continue to follow your existing process for claim reconsiderations that do not require attachments.
UnitedHealthcareOnline.com Password Owners and ID Administrators can register from the User ID & Password Management page and then initiate the registration process for Standard Users, who will receive an email invitation to complete the registration process..
*Cloud computing refers to shared resources and information housed in a “cloud” on the internet that you can securely access from your web browser from any internet connection.
Optum Cloud Dashboard
1212Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
There are a few things you can do now to prepare for the Optum Cloud Dashboard:
Everyone who registers for the Optum Cloud Dashboard must have a unique email address. If you currently share an email address with other UnitedHealthcareOnline.com users, please create your own email and then login to update the My Account page.
If you currently share a User ID with another UnitedHealthcareOnline.com user, we encourage you to set up your own User ID now.
If you use a browser version lower than Internet Explorer 8, Firefox 10 or Safari 5, consider updating to a higher version for best viewing and make sure that JavaScript is enabled.
Optum Cloud Dashboard
13Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Optum Cloud Dashboard Registration: • 3rd Wednesday of every month (Q&A afterward)
Optum Cloud Dashboard Applications* (Claims Reconsideration, Eligibility & Benefits Center and Claims Management)• Every Wednesday & Thursday of each week
Optum Cloud Dashboard
13
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
14Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
ICD-10
15
Website
UnitedHealthcare’s ICD-10 Website
UnitedHealthcare’s ICD-10 website allows our delivery-side partners to receive information when they need it.
Go to: www.unitedhealthcareonline.com It provides access to:
• Education
On-demand education module and PowerPoint presentations
• Tools
- ICD-10 Code Decision Trees
- ICD-10 Code Look Up Tool
• Resources
- ICD-10 focused website links
• Partnerships—including low cost offerings such as:
- AAPC discounts on ICD-10 Education @ www.aapc.com/uhc
- Optum ICD-10 Self Assessment Toolkit click here
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
UHC2231l_20130611
16Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
ICD-10 Assistance?
ICD-10 Questions can be sent to:
Aaron R. SappNational ICD-10 Program Director
303-984-1897
UHC2231l_20130611
17Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Updates
18Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
September Network Bulletin
• Delay of New Outpatient and Professional Therapy Functional Reporting Requirement
• Prior Authorization Requirement for Outpatient Injectable• Discontinuation of the ANN Form and Changes to the Charging• Customers for Non-covered Services Protocol• Electronic Payments & Statements is Expanding• UnitedHealthcare’s Medicare Advantage Part B Specialty• Drug Prior Authorization Program Terminated
19
UnitedHealthcare Provider Relations and Service Team
Your Partner for Claims and Service Needs:
Navigational specialist
One contact for all UnitedHealth Group companies
Assistance with education; self-service tools
Help with service issues
Works to maximize the ability of practices to interact with UnitedHealthcare
20
Questions?
Thank you for attending!