Provider Relations September 2014

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

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Advocates &Network Management

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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!

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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

http://www.unitedhealthcareonline.com/

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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

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Prior Authorization/Notifications


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


Optum Cloud Resources


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


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 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


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Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.


ICD-10

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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

https://www.unitedhealthcareonline.com/b2c/CmaAction.do?channelId=6fa2600ae29fb210VgnVCM1000002f10b10a____



http://www.aapc.com/uhc

https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/OPTPRJ1019SelfAssmtPHYSCN_FNL_HR.pdf


ICD-10 Assistance?

ICD-10 Questions can be sent to:

[email protected]

Aaron R. SappNational ICD-10 Program Director

303-984-1897

[email protected]

UHC2231l_20130611

mailto:[email protected]?subject=ICD-10%20Question

mailto:[email protected]


Updates


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

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UnitedHealthcare Provider Relations and Service Team

Your Partner for Claims and Service Needs:

[email protected]

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

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Questions?

Thank you for attending!

Provider Relations September 2014

Documents

Transcript of Provider Relations September 2014