UnitedHealthcare IMGMA 2017
|
|
|
- Erik Austin
- 5 years ago
- Views:
Transcription
1 UnitedHealthcare IMGMA 2017
2 Indiana Advocates 2
3 Exciting changes are forthcoming! 3
4 eligibilitylink Voluntary usage deployed on , forced usage deployed on Patient Eligibility & Benefits removed from UHCO Features Primary tasks simplified, results consolidated into single page Customizable settings, to fit your needs and workflow Expanded benefit details, medical & therapy accumulators, gaps in care View all effective policies, COB information, grace periods, ID cards Easily manage prior authorizations, attachment capability Live WebEx training UHCO > Tools & Resources > Training & Education eligibilitylink & claimslink UHC On Air Select Indiana, select Transition to eligibilitylink Tutorial 4
5 claimslink Voluntary usage deploying on and forced usage deploying on Claims & Payments being removed from UHCO Features Expanded claim line level payment details, including clinical and reimbursement policy Easily flag claims to monitor and follow up Simplified denial management with electronic attachments, and status monitoring Account recovery reconciliation Live WebEx training UHCO > Tools & Resources > & Education eligibilitylink & claimslink Training 5
6 My Practice Profile New application on Link which will allow you to update demographic information for your providers. Name, address, phone number, specialty and acceptance of new patients, etc. can currently be updated Directory indicators and other information in development Link users will receive the upgraded My Practice Profile app in phases through We ll send you a notification when you have access to the upgraded app. Currently available to physician practices. Availability for hospitals and other facilities in development. You must have submission/updating rights to make changes to the demographic information for your practice. (Link Password Owners or ID Administrators determine who has access.) To learn more about using My Practice Profile, please go to UnitedHealthcareOnline.com > Help > Link: Learn More > My Practice Profile & Attestation 6
7 My Practice Profile Attestations Following CMS requirements, providers are required to attest to the accuracy of their demographic information each quarter (see page 10 of the 2017 Administrative Guide). A 90 day timer will be reset each time an attestation is completed. Attestations must be completed using the upgraded My Practice Profile app on Link. Each person in your organization with access to view/update information in My Practice Profile will receive ed reminders. In addition, there will be a reminder on My Practice Profile that tells your attestation deadline. If your practice has 30 or fewer care providers, you can complete your attestation by signing in to UnitedHealthcareOnline.com to access Link, then: Select My Practice Profile, Select Verify Demographic Info, Select Make Attestation Decision, Click I Attest. 7
8 My Practice Profile Resources UnitedHealthcareOnline.com > Help > Link: Learn More > My Practice Profile & Attestation Care Provider Demographic Data Attestation FAQs (also found on UHCO, Link Learn More) Home > Tools & Resources > Training & Education Select My Practice Profile Sessions last 30 minutes and are available on a bi-weekly basis UHC on Air Select Indiana, select Link My Practice Profile App Upgrade 8
9 Link Resources UHCO > Help > Link Learn More UHCO > Tools & Resources > Health Information Technology > Link: Learn More QRG app on Link Dashboard for step by step instructions UHC On Air Live WebEx training UHCO > Tools & Resources > Training & Education eligibilitylink & claimslink My Practice Profile Link applications* Claims Reconsideration, Eligibility & Benefits Center and Claims Management (use only until claimslink rolls out) 9
10 Claim Dispute Resolution Process 10
11 Claim Dispute Resolution Process 1. Submit a claim reconsideration form Link, remember to go to Claims Management to locate your claim Paper (least preferred method) 2. Contact your Provider Advocate Provide claim information 11
12 Claim Dispute Resolution Process 3. Submit a request for formal appeal Prepare a written letter providing specific reasons on why you believe the claim is payable Attach new information not previously submitted Specific address for appeals 2 nd level appeal accepted ONLY if new Information is received 12
13 Things to remember Provider Advocates can only step in when a claim has failed the Customer Service model. We must ask that you try to resolve the claim dispute via a claim reconsideration form as this is the first step in UHC s claim dispute resolution process. Submit a claim reconsideration via Link rather than calling Customer Service. You must submit your Claim Reconsideration and Formal Appeal within 12 months from the date of the Explanation of Benefits (EOB) or Provider Remittance Advice (PRA). 13
14 Affiliate Plans Home > Tools & Resources > EDI Education for Electronic Transactions > Payer List for UnitedHealthcare, Affiliates and Strategic Alliances 14
15 Cover area with cropped image. Do not overlap blue bar. Completely cover gray area. Cover area with cropped image. Do not overlap blue bar. Completely cover gray area. Cover area with cropped image. Do not overlap blue bar. Completely cover gray area. Medicare Advantage Products
16 2017 Medicare Group Numbers Plan Name Group IDs AARP MedicareComplete *Focus (PPO) *FOCUS is a Lutheran (Fort Wayne) based PPO any provider with a Medicare amendment with us is automatically in-network for this plan EXCEPT any provider employed by Parkview these members also DO have out of network benefits. AARP MedicareComplete **Profile (HMO) **PROFILE is a Parkview (Fort Wayne) based HMO any provider with a Medicare amendment with us is automatically in-network for this plan EXCEPT any provider employed by Lutheran these members do NOT have out of network benefits. AARP MedicareComplete Plan 1 (HMO) This plan does not have Out of Network coverage AARP MedicareComplete Plan 2 (HMO) This plan does not have Out of Network coverage AARP MedicareComplete Choice (PPO) This plan has In and Out of Network coverage and and , 00703, 00704, 00705, 00709, 00710, 00721, 00722, 00739, 00740, and , 00713, 00714, 00720, and , 67017, 67018, 67024, 67025, and **Indiana Medicare Advantage plans do not require referrals.** 16 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
17 Passport What is Passport? Passport is a benefit for our Medicare Advantage members that allows members to receive covered services outside of their home service area for up to nine consecutive months when traveling. Covered services must be provided by UnitedHealthcare Medicare-contracted providers in participating service areas. Members only pay their usual copayment or coinsurance when their Passport is activated. How can I tell what the Home Service Area is? If a member presents an AARP Medicare Complete Card with a group number that begins with something other than a 6 or 007, they have an out of state plan and must activate their Passport benefit in order to receive services in Indiana at their in-network benefit level. What happens if the Passport is not activated? Claims will process out of network applying a higher co-pay and/or co-insurance. 17 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
18 Passport 18 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
19 Passport Where can I get more info? Home > Tools & Resources > Products &Services > Medicare > HMO, POS & PPO > 2016 UnitedHealth Passport Benefit 19 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
20 Medicare Resources Home > Tools & Resources > Medicare HMO, POS and PPO info PATH (Star ratings and HEDIS measures) PPO - Group Retiree PFFS (Private Fee-For-Service) Waiver of Liability info for non-contracted Medicare providers 20 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
21 Navigate 21
22 Important Info to Know: Members select a PCP to manage care Referrals are required for services provided by physicians outside of the PCP s TIN. Referrals must be submitted electronically via the portal No retro referrals Members are financially responsible when claims process without a referral Responsibility percentage differs by benefit plan. 22
23 Navigate Health Care ID Cards This sample ID card is for illustration only. Actual information varies depending on payer, plan and other requirements. 23
24 Additional Resources For specific product information and Navigate resources please visit Home > Tools & Resources > Products & Services > UnitedHealthcare Navigate Insurance coverage provided by UnitedHealthcare Insurance Company or its affiliates. Health plan coverage provided by UnitedHealthcare of Arizona, Inc., UnitedHealthcare of California, UnitedHealthcare of Colorado, Inc., UnitedHealthcare of Oregon, Inc., UnitedHealthcare of Utah, Inc. and UnitedHealthcare of Washington, Inc. or other affiliates. Administrative services provided by United HealthCare Services, Inc. or its affiliates. Doc#: UHC1926x_
25 Preventive Care Preventive Care Services Coding Guideline Summary (commercial) Home > Tools & Resources > Policies, Protocols and Guides > Medical & Drug Policies and Coverage Determination Guidelines - Commercial Medicare Advantage Annual Wellness, Welcome to Medicare and Preventive Screening Guidelines Home > Tools & Resources > Medicare > Reference Materials > 2017 Medicare Advantage Preventive Services Coding Guidelines 25
26 Reminders! Utilize Link for claim reconsiderations, claims status and eligibility & benefits rather than calling Customer Service Register for WebEx trainings on Link Reach out to your dedicated Advocate for assistance if a claim reconsideration fails the UHC service model Sign up for the Network Bulletin on UHCO Attend our 2 nd annual Provider Information Expo later in 2017 Invites will be delivered via Access UHC On Air app via Link to watch videos and learn more about UHC processes, products and tools 26
27 Questions? 27
KanCare All MCO Training. Fall 2018
KanCare All MCO Training Fall 2018 Welcome, Introductions & Agenda Welcome Introductions United HealthCare Agenda for the day Provider Specific afternoon Session 1:00 p.m. to 4:30 p.m. Break out tables
Medicaid Modernization: How to Build a Relationship with an MCO
Medicaid Modernization: How to Build a Relationship with an MCO 2015/2016 Agenda Building a positive relationship with providers is critical to a smooth transition to managed care. We are here to help
Summary of Changes - New Enrollment and Claims Payment System Effective June 1, 2017
Overview Starting June 1, 2017, UnitedHealthcare Community Plan in Florida will change to a new enrollment and claims payment system. This Summary of Changes is a guide to help answer questions you may
Medicare prescription drug plans (Part D)
Medicare prescription drug plans (Part D) Medicare prescription drug plans (Part D) Help with prescription drug costs Works differently from Original Medicare Part A and Part B. You can only get Medicare
RECONTRACTING 10/31/2016. Aetna Medicare Advantage. Aetna Behavioral Health
DOING BUSINESS WITH AETNA & COFINIT Y 1 2 RECONTRACTING -Separate agreements. -Separate networks. - Aetna is a Payer, Cofinity is a Network Access Agreement. Aetna Medicare Advantage Employer Based Plan.
UnitedHealthcare Community Plan of Missouri
UnitedHealthcare Community Plan of Missouri Agenda UnitedHealthcare Community Plan of Missouri Member Eligibility and Benefits Notification and Prior Authorization Claims Management Care Provider Resources
Introduction to UnitedHealthcare Community Plan of California/Medi-Cal
Introduction to UnitedHealthcare Community Plan of California/Medi-Cal Welcome/Agenda: Mission/Vision UnitedHealthcare Community Plan of California/Medi-Cal Member Eligibility and Benefits Notification
Dual Special Needs Plans, Behavioral Benefit
Dual Special Needs Plans, Behavioral Benefit Offered by UnitedHealthcare Dual Complete Launch Date January 1, 2019 Contents What are Dual Special Needs Plans (DSNPs)? UnitedHealthcare Dual Complete Behavioral
Claim Submission Process Training For Individual Consumer-Directed Attendant Care Providers
Claim Submission Process Training For Individual Consumer-Directed Attendant Care Providers Topics Overview Accessing Online Self-Service Tools Billing the Member Claim Submission Forms Claim Submission
Having a plan designed to work for you.
YOUR ADVANTAGE: Having a plan designed to work for you. Northwestern University Post- 65 Retiree 2018 Benefit Plans Y0066_170927_092703 Proprietary information of UnitedHealth Group. Do not distribute
United healthcare insurance resubmission of claim timly filing United healthcare insurance resubmission of claim timly filing
United healthcare insurance resubmission of claim timly filing United healthcare insurance resubmission of claim timly filing Specialty Pharmacy Requirements for Certain Commercial Specialty Medications.
New 2019 Health Care Plan information for all Colorado PERA Retirees Updated
New 2019 Health Care Plan information for all Colorado PERA Retirees Updated Anthem Blue Cross and Blue Shield (Anthem) would like to provide new 2019 health plan information for Colorado Public Employee
If you have any questions regarding this waiver, please call the Provider Service line at
May 3, 2013 Dear Health Care Provider and Beneficiary: This letter is to confirm that effective immediately, no authorization will be required for TRICARE covered benefits that would otherwise require
Training Documentation
Training Documentation Substance Abuse Rehab Facilities 2017 Health care benefit programs issued or administered by Capital BlueCross and/or its subsidiaries, Capital Advantage Insurance Company, Capital
STARs Program and SETMA s Solution By James L. Holly, MD Your Life Your Health The Examiner April 26, 2012
STARs Program and SETMA s Solution By James L. Holly, MD Your Life Your Health The Examiner April 26, 2012 Increasingly, health plans and particularly Federal programs are requiring evidence of quality
Northern Arizona Provider Town Hall
Northern Arizona Provider Town Hall 1 Agenda 01 02 03 04 Welcome Remarks and Introductions Ron Haase Chief Human Resources Officer Northern Arizona Healthcare About UMR Washington Covena / Marisa Aragon
Provider relationships are very important to consumers and network status is part of their decision making process.
Provider Search Ancillary Benefit Providers September 2017 Provider relationships are very important to consumers and network status is part of their decision making process. The purpose of this user guide
Claim Reconsideration Requests Reference Guide
Claim Reconsideration Requests Reference Guide This reference tool provides instruction regarding the submission of a Claim Reconsideration Request form and details the supporting information required
Claims Claim Submission QUICK REFERENCE
Claims Claim Submission QUICK REFERENCE This will review the process of how to submit a claim online and check the status of a previously submitted claim. Get Started 1. From, click Link and sign in NOTE:
Working with Anthem Subject Specific Webinar Series
Working with Anthem Subject Specific Webinar Series BlueCard Program Introduction Access to Audio Portion of Conference: Dial-In Number: 877-497-8913 Conference Code: 1322819809# Please Mute Your Phone
Genetic and Molecular Lab Testing Notification/Prior Authorization Process Frequently Asked Questions Effective Nov. 1, 2017
Genetic and Molecular Lab Testing Notification/Prior Authorization Process Frequently Asked Questions Effective Nov. 1, 2017 Key Points Starting Nov. 1, 2017, notification/prior authorization is required
For Participants in the Management Retiree Plan Design
INFORMATION AND ACTION GUIDE 2012 Benefits Enrollment This package contains everything you need to make your enrollment decisions, including: This guide; Your personalized enrollment worksheet; and Benefits
Prior Authorization for Outpatient Injectable Chemotherapy Frequently Asked Questions
Prior Authorization for Outpatient Injectable Chemotherapy Frequently Asked Questions Key Points We require prior authorization for injectable chemotherapy given in an outpatient setting to a member who
Provider-Level Adjustments
835 Solutions Provider-Level Adjustments The basics Locating PLBs Provider-level adjustments can increase or decrease the transaction payment amount. Adjustment codes are located in PLB03-1, PLB05-1, PLB07-1,
Answers to Frequently Asked Questions Comprehensive Quality & Risk Program
Answers to Frequently Asked Questions Comprehensive Quality & Risk Program What is the Comprehensive Quality & Risk Program? The Comprehensive Quality & Risk Program is a chronic conditions quality of
TODAY S AGENDA. Opening Comments, Kevin B. Huber, CTPF executive director. Open Enrollment Overview. Enrollment and Eligibility
2 TODAY S AGENDA Opening Comments, Kevin B. Huber, CTPF executive director Open Enrollment Overview Enrollment and Eligibility 2013 Health Plan Options 3 STATE OF PENSION FUND Illinois Pension Reform The
Here s Your 2014 Annual Enrollment Guide
2014 Annual Enrollment Benefits Information Welcome! Here s Your 2014 Annual Enrollment Guide Learn Evaluate Enroll Doug Clauson with his family (Berkeley, Mo.) This guide outlines your 2014 health care
Overview of Plans for Medicare Eligible Members
Overview of Plans for Medicare Eligible Members The following pages offer general descriptions of the types of plans offered to CTPF retirees who are eligible for and maintain active enrollment in Medicare
ISMA Coalition Meeting September 13, 2013
ISMA Coalition Meeting September 13, 2013 Questions and Answers 1. For OMPP and each MCE: When will all the Medicaid payers be able to accept electronic claims (837 files) for secondary claims with Primary
Understanding the Insurance Process
Understanding the Insurance Process This summary provides an overview of the health insurance process. Health insurance falls into two major categories: commercial insurance and government insurance. Commercial
Excellus BlueCross BlueShield Provider Relations Fall Seminar
Excellus BlueCross BlueShield Provider Relations Fall Seminar Agenda Product Updates Safety Net Clear Coverage Authorization Tool Website Updates EDI Updates Clinical Editing BlueCard Medicare Updates
Healthcare Benefits for NJM s Medicare-eligible Retirees, Spouses and Surviving Spouses
Healthcare Benefits for NJM s Medicare-eligible Retirees, Spouses and Surviving Spouses About this guide This guide explains the steps you must take to ensure that you make sound, timely choices regarding
LEARNING WHAT IT TAKES TO BILL MANAGED CARE INSURANCES
home health LEARNING WHAT IT TAKES TO BILL MANAGED CARE INSURANCES Lynn Labarta, CEO, Imark Billing 1 home health LYNN LABARTA CEO, Imark Billing Founder of Imark Billing with over 15 years experience
Specialty Drug Medical Benefit Management
Specialty Drug Medical Benefit Management Agenda Introduction Specialty Medical Benefit Management (SMBM) Strategy Prior Authorization Process Other Important Information Provider Tools Provider Relations
DENTAL NEWSLETTER Third Quarter 2018
Third Quarter 2018 Appointment availability requirements for Maryland. Effective immediately, all PPO Providers in Maryland are required to follow these appointment availability standards: Urgent appointment
PROVIDER SERVICES Section IV Provider Services
Section IV Provider Services Provider Services 98 NaviNet www.navinet.net Using NaviNet reduces the time spent on paperwork and allows you to focus on more important tasks patient care. NaviNet is a one-stop
2016 NATIONWIDE RETIREE BENEFITS BULLETIN
2016 NATIONWIDE RETIREE BENEFITS BULLETIN This bulletin describes benefit changes and coverage provisions effective Jan. 1, 2016. After you ve reviewed the information, decide if you need to make a change
Maine Chapter of the Healthcare Financial Management Association. MaineCare Provider Relations
Maine Chapter of the Healthcare Financial Management Association MaineCare Provider Relations Agenda New Drug Testing Laboratory Codes Improve your Search for Prior Authorization (PA) Completing Pathways
Electronic Payments & Statements
Electronic Payments & Statements Topics What are Electronic Payments & Statements (EPS)? Common Terminology How You Save With Electronic Remittance Advice/Electronic Funds Transfer (ERA/and EFT) Automated
Cenpatico South Carolina Frequently Asked Questions (FAQ)
Cenpatico South Carolina Frequently Asked Questions (FAQ) GENERAL Who is Cenpatico? Cenpatico, a division of Centene Corporation, is one of the nation s most experienced behavioral health companies providing
Quality health plans & benefits Healthier living Financial well-being Intelligent solutions October 2016 AAHAM Updates
Quality health plans & benefits Healthier living Financial well-being Intelligent solutions October 2016 AAHAM Updates Debby Synowicki Sr. Provider Relations Representative Aetna s Values Wheel 2 Aetna
Innovation Health At-A-Glance
Innovation Health At-A-Glance A quick reference guide for health care professionals 71.02.801.1 A (3/15) innovation-health.com A guide for doing business with Innovation Health Getting started with Innovation
Eligibility and Benefits Inquiry Guide
Eligibility and Benefits Inquiry Guide February 2018 Independence Blue Cross offers products through its subsidiaries Independence Hospital Indemnity Plan, Keystone Health Plan East, and QCC Insurance
Frequently Asked Questions
NOTES Frequently Asked Questions TURNING AGE 65 Q I AM TURNING AGE 65 IN 2014. WHAT SHOULD I DO? Contact your local Social Security Administration (SSA) office or call 1-800-772-1213 to enroll in Medicare
Continuing State Group Insurance Benefits as a Retiree
Continuing State Group Insurance Benefits as a Retiree Erin Rock, Secretary Be sure to keep your address up-todate in People First Learning More Once action is entered in People First - State Group Insurance
Medicare Advantage Explained 2008
Medicare Advantage Explained 2008 Getting More from Your Medicare Benefits An educational resource from 4 Medicare Basics 7 About Medicare Advantage 9 Medicare Advantage Options 12 Reviewing Your Choices
National Grid Retiree Club Meeting Long Island. October 2, 2017
National Grid Retiree Club Meeting Long Island October 2, 2017 18 Agenda Definitions 2018 Highlights for Management Retirees & Dependents Under Age 65 2018 Highlights for Local 1049 Retirees & Dependents
Summary of Benefits. January 1 December 31, 2011
Summary of Benefits January 1 December 31, 2011 Section 1: Introduction to the Summary of Benefits Report for Medco Medicare Prescription Plan (PDP) January 1, 2011 December 31, 2011 Thank you for your
Over the past several months, HMSA announced its plans to convert to a new
HMSA s For Participating Providers August 2007 INSIDE Referral exceptions 2 Administrative review 2 Behavioral health services 3 Health center operations 3 Tax reporting: HMO and federal plans 4 Fee schedule
Continuing State Group Insurance Benefits as a Retiree
Continuing State Group Insurance Benefits as a Retiree Erin Rock, Secretary Be sure to keep your address up todate in People First Learning More Once action is entered in People First State Group Insurance
Alyeska Pipeline Service Company Retiree Medicare Eligible Reimbursement Health Plan
Alyeska Pipeline Service Company Retiree Medicare Eligible Reimbursement Health Plan This guide explains your upcoming Alyeska post age 65 retirement healthcare benefits, and the steps you must take to
Webinar Schedule Join us for our next webinar! Are you a newly contracted Provider? Existing Provider who has new staff? Would your office like to lea
Fall 2018 Provider Newsletter What s New? Provider Services Phone Number 888-243-3312 We are excited to share a change with you! Our dedicated Provider Services telephone number launched on November 1
Innovation Health At-A-Glance
Innovation Health At-A-Glance A quick reference guide for health care professionals 71.02.801.1 (8/13) innovation-health.com A guide for doing business with Innovation Health Getting started with Innovation
Ambetter and Allwell 1 st Quarterly Webinar April 12 th, 2018
Ambetter and Allwell 1 st Quarterly Webinar April 12 th, 2018 Conference Number: (855) 351-5537 Conference Code: 741 390 3784 If you haven t already, please call into the webinar to hear us speak. Your
Provider Training Program. Date
Mountain State Blue Cross Blue Shield Provider Training Program Presenter Date Provider Training Program Agenda Welcome and Opening Remarks About NIA The Provider Partnership The Program Components The
Anthem Blue Cross and Blue Shield. Serving Hoosier Healthwise and Healthy Indiana Plan
Anthem Blue Cross and Blue Shield Serving Hoosier Healthwise and Healthy Indiana Plan 3rd Quarter Updates NDC Denials The following elements are required for claims with NDC information J code NDC N4
PROVIDER MANUAL. Revised January Page 1
PROVIDER MANUAL Revised January 2018 Page 1 Table of Contents Introduction 3 General Information 4 Who Do I Call? 5 ID Card Logos 6 Credentialing/Recredentialing 7 Provider Changes 8 Referral and Authorization
Associated Construction & Engineering, Inc.
Associated Construction & Engineering, Inc. Benefit Enrollment Guide January 1, 2019 Company-Sponsored Benefit Plans for Health, Wellness, and Peace of Mind Open Enrollment will be open from November 19,
Coverage Determinations, Appeals and Grievances
Coverage Determinations, Appeals and Grievances Filing a grievance (making a complaint) about your prescription coverage Asking for a coverage determination (coverage decision) 60-day formulary change
0518.PR.P.PP.2 7/18. The Ins and Outs of CMS 1500 Billing
0518.PR.P.PP.2 7/18 The Ins and Outs of CMS 1500 Billing AGENDA Claim Process Creating Claim on MHS Web Portal Reviewing Claims Claim Denial Claim Adjustment Dispute Resolution Taxonomy Allwell Information
Understanding Your Medicare Options. Medicare Made Clear
Understanding Your Medicare Options Medicare Made Clear Top Medicare questions 1 Who is eligible for Medicare? 2 What are my coverage options? 3 When can I enroll? 4 What are my next steps? 5 Once I am
ancillary claims filing requirements: specialty pharmacy
ancillary claims filing requirements: specialty pharmacy Presented by: Valesca Weerasinghe, Network Manager Ancillary & Specialty Networks Blue Shield of California September 26, 2012 agenda objectives
Claims Submission Process Overview. For Consumer-Directed Attendant Care and Waiver Care Providers
Claims Submission Process Overview For Consumer-Directed Attendant Care and Waiver Care Providers Agenda Member Liability Claims Submission CMS-1500 Form Claims Reconsideration Member Liability for Payment
GLMS UHC IIRC Thursday, March 24, 2016 GLMS/First Floor Boardroom 7:30AM
GLMS UHC IIRC Thursday, March 24, 2016 GLMS/First Floor Boardroom 7:30AM Committee Members in Attendance in Bold Brian Sosnin, DO UHC IIRC Chair Julie Daftari, MD UHC KY Medical Director Billy McCord UnitedHealthcare
Working with Anthem Subject Specific Webinar Series
Working with Anthem Subject Specific Webinar Series Provider Claim Submission and Adjustment Request Tips and Tools Access to Audio Portion of Conference: Dial-In Number: 877-497-8913 Conference Code:
National Imaging Associates, Inc. (NIA) Frequently Asked Questions (FAQ s) For Aetna New York Providers Performing Physical Medicine Services
National Imaging Associates, Inc. (NIA) Frequently Asked Questions (FAQ s) For Aetna New York Providers Performing Physical Medicine Services Question Answer General Who is National Imaging Associates,
Anthem Blue Cross. CCHCA Physician Handbook (7 th Edition)
Part II Section B Introduction 1 Verifying Member Eligibility and Benefits 1 Sample Member ID Card 2 Eligibility Certification Form 3 CCHCA Physician Handbook (7 th Edition) INTRODUCTION, created in 1986
HealthChoice Illinois
HealthChoice Illinois November 2017 Presented by: Matt Wolf and Lori Lomahan Meeting Agenda Introductions Credentialing Update Billing Instructions Claims Adjudication Reimbursement Methodology MCO Website
COMPASS ROSE HEALTH PLAN PROTECTING OUR MEMBERS SINCE 1948
PLAN YEAR 2019 COMPASS ROSE HEALTH PLAN PROTECTING OUR MEMBERS SINCE 1948 POWERED BY compassrosebenefits.com 1 WELCOME WE ARE HERE TO HELP YOU SOLVE THE COMPLEXITIES OF INSURANCE PLAN HIGHLIGHTS COMPASS
Chevron Retirees Association. October 15 December 7, 2017
Chevron Retirees Association Chevron / OneExchange Open Enrollment October 15 December 7, 2017 The Chevron Retirees Association is not a subsidiary of the Chevron Corporation but an independent, non-profit
NATIONAL DRUG CODES. Claim Submission & Inquiry Procedures
NATIONAL DRUG CODES NATIONAL DRUG CODES Overview of National Drug Codes (NDC) Claims... 3 Section One How to Submit NDC Claims... 3 Section Two Types of NDC Claims... 4 Section Three NDC Claim Requirements...
F R E Q U E N T L Y A S K E D Q U E S T I O N S UnitedHealthcare Group Medicare Advantage PPO Plan
F R E Q U E N T L Y A S K E D Q U E S T I O N S UnitedHealthcare Group Medicare Advantage PPO Plan A. General Information About the UnitedHealthcare Group Medicare Advantage PPO Plan... 1 1. Why is Johnson
RETAIL PREMIUM PAYMENT GUIDE for Producers Processes & Options for Submitting Initial & Ongoing Premiums
Over 65 RETAIL PREMIUM PAYMENT GUIDE for Producers Processes & Options for Submitting Initial & Ongoing Premiums Making the First Month s Premium... 2 Overview of Payment Options for Paying the First Month
Douglas County Community Provider Outreach January 2018
Douglas County Community Provider Outreach January 2018 Douglas County Gold Rx Plan Changes Description 2017 In-Network / Out-of-Network 2018 In-Network / Out-of-Network Gold Rx Premium $180 $189 Ambulance
FIND A DOCTOR Page 1 of 22
www.hometownhealth.com FIND A DOCTOR Page 1 of 22 Type in Name of Doctor OR ADVANCED SEARCH You can filter your results by: Provider Last OR Group Name Provider Type City County Specialty Plan Zip Code
Forms & Publications: Manuals, Bulletins, Quick Points, Provider Press. Administrative Updates: Forms for Demographic Changes
MMGMA DAY WITH THE PAYERS May 19, 2016 Janet Benton, Director Provider Relations Kate Mikonowicz, Network Management Consultant, Pr. Shannon Hoskin, Network Management Consultant, Sr. Blue Cross and Blue
summary of benefits Blue Shield of California Medicare Rx Plan (PDP)
summary of benefits Blue Shield of California Medicare Rx Plan (PDP) An employer-sponsored Medicare Prescription Drug Plan for City and County of San Francisco retirees, spouses and eligible dependents
Klamath County Community Provider Outreach January 2018
Klamath County Community Provider Outreach January 2018 Klamath County Gold Rx Plan Changes (In-network/Out-of-network) Description 2017 2018 Gold Rx Premium $180 $189 Ambulance $100 $150 Emergency $65
2018 Quick Reference Guide
Effective: 01-01-2018 AARP MedicareComplete (HMO): H1045-030 & H1045-043 AARP MedicareComplete Choice Plan 2 (Regional PPO): R7444-003 AARP Medicare Complete Choice Essential (Regional PPO): R7444-004
EGWP Frequently Asked Questions For SSC & USG Benefits Administrators
EGWP Frequently Asked Questions For SSC & USG Benefits Administrators Q. Why is the USG utilizing a Medicare part D plan as part of their pharmacy coverage? A. Due to Health Care Reform, Pharmaceuticals
COMPASS ROSE HEALTH PLAN PROTECTING OUR MEMBERS SINCE 1948
PLAN YEAR 2018 COMPASS ROSE HEALTH PLAN PROTECTING OUR MEMBERS SINCE 1948 POWERED BY compassrosebenefits.com 1 WELCOME WE ARE HERE TO HELP YOU SOLVE THE COMPLEXITIES OF INSURANCE PLAN HIGHLIGHTS COMPASS
Wright State University. Managing Your Medical Plan
Wright State University Managing Your Medical Plan 2016 Medical Plans Benefit Year: 1/1/2016 12/31/2016 In-Network 90/10 Plan 80/20 Plan HDHP Calendar Year Deductible Co-Insurance Out-of Pocket Maxi $125/$250
Working with Anthem Subject Specific Webinar Series
Working with Anthem Subject Specific Webinar Series Provider Claim Submission and Adjustment Request Tips and Tools Access to Audio Portion of Conference: Dial-In Number: 877-497-8913 Conference Code:
General Who is National Imaging Associates, Inc. (NIA)?
National Imaging Associates, Inc. (NIA) Frequently Asked Questions (FAQ s) For Aetna/Coventry West Virginia Providers Performing Physical Medicine Services Question General Who is National Imaging Associates,
SutterSelect Administrative Manual. June 2017
SutterSelect Administrative Manual June 2017 Introduction This SutterSelect Administrative Manual has been prepared as a resource for providers who are caring for members of SutterSelect health plans.
Magellan Claims Settlement Practices and Dispute Resolution Notice to Providers Contracted with California Subsidiaries of Magellan Health, Inc.
Magellan Claims Settlement Practices and Dispute Resolution Notice to Providers Contracted with California Subsidiaries of Magellan Health, Inc.* Revised effective Nov. 15, 2016 *Human Affairs International
Summary of Benefits. My RxBLUE (PDP). Medicare prescription drug plan from the Cross and Shield 10MX0010 R1/11 S5937_091010AMFU
2011 Summary of Benefits 2011 My RxBLUE (PDP). Medicare prescription drug plan from the Cross and Shield 10MX0010 R1/11 S5937_091010AMFU Summary of Benefits for RxBLUE (PDP) January 1, 2011 December 31,
Blue Cross Blue Shield of Texas Replacing Aetna PPO Medical Plan Changes New Health Care Partners for Dental and EAP Improved Dental Plan Benefits
2014 Annual Enrollment Blue Cross Blue Shield of Texas Replacing Aetna PPO Medical Plan Changes New Health Care Partners for Dental and EAP Improved Dental Plan Benefits 2014 Annual Enrollment November
CLARIFYING INSURANCE CLAIMS What is an Insurance Claim?
CLARIFYING INSURANCE CLAIMS What is an Insurance Claim? Often those in the scleroderma community find themselves frequenting health care providers and being left with mounds of invoices and bills. Medical
MHS CMS 1500 Tips and Billing Guidelines
MHS CMS 1500 Tips and Billing Guidelines AGENDA Creating Claim on MHS Web Portal Claim Process Claim Rejection Claim Denial Claim Adjustment Dispute Resolution Taxonomy Eligibility Reviewing Claims DME
During This Phase, We Recommend You Take These Steps:
The Basics of Billing and 1 The Basics of Billing and Introduction 2 Phase 1 Welcome to Cleveland l Clinic List Phase 1 Billing Facts: 1. My Policy ID number is. 2. My Group ID number is. 3. My insurance
11/1/2016. Molina Healthcare of Michigan. Prior Authorizations. Third Party Payer Day Julie Hurst. Director, Provider Contracting and Services
Third Party Payer Day Julie Hurst 1 Director, Provider Contracting and Services November 11, 2016 Molina Healthcare of Michigan 2000 2006 Awarded Medicaid contract as licensed HMO and begin serving 22,000
Kyrene Employee Benefits Trust. Get benefits that make it easier to focus on your health, not your health care.
Kyrene Employee Benefits Trust Get benefits that make it easier to focus on your health, not your health care. HEALTH BENEFITS 7/1/17 What We Will Cover Today 1 Premium Plan 2 3 4 Standard Plan Base Plan
Helping You Prepare For Your Upcoming Medicare Enrollment
Welcome PEBP 1 Helping You Prepare For Your Upcoming Medicare Enrollment October, 2016 2016 Willis Towers Watson. All rights reserved. OneExchange Who We Are Your Future Coverage OneExchange For Your Benefit
Simple Facts About Medicare
Simple Facts About Medicare What is Medicare? Medicare is a federal system of health insurance for people over 65 years of age and for certain younger people with disabilities. There are two types of Medicare:
20. CLAIMS PROCESSING. A. Claims Processing APPLIES TO: A. This policy applies to all IEHP Medi-Cal Providers. POLICY:
A. Claims Processing APPLIES TO: A. This policy applies to all IEHP Providers. POLICY: A. All Capitated Providers are delegated the responsibility of claims processing for non- Capitated services and are
NEWS. Welcome to the New ilinkblue! ilinkblue Features. March
NEWS A special edition newsletter for Blue Cross and Blue Shield of Louisiana network providers. March 2017 Welcome to the New ilinkblue! Blue Cross and Blue Shield of Louisiana s ilinkblue has received
Farm Bureau Select Rx 2017 Summary of Benefits January 1, December 31, 2017
P.O. Box 266380 Weston, FL 33326 Farm Bureau Select Rx 2017 Summary of Benefits January 1, 2017 - December 31, 2017 Thank you for your interest in Farm Bureau Select Rx, Our plan is offered by Members
NON-CONTRACT PROVIDER DISPUTE AND APPEALS PROCESS. For Post-Service Claim Payment Issues Following an Initial Organization Determination
NON-CONTRACT PROVIDER DISPUTE AND APPEALS PROCESS For Post-Service Claim Payment Issues Following an Initial Organization Determination Y0067_CLAIMS_DisputeAppeals_Non-ContractProv_0114_IA 02/11/2014 Table
The information presented in this Webinar is current as of date of live airing July 16, Emily Putnam Senior Manager, Sales
The information presented in this Webinar is current as of date of live airing July 16, 2014 Emily Putnam Senior Manager, Sales Evaluate your current self-pay strategy Explore how practice management can