Northern Arizona Provider Town Hall

Transcription

1 Northern Arizona Provider Town Hall 1

2 Agenda Welcome Remarks and Introductions Ron Haase Chief Human Resources Officer Northern Arizona Healthcare About UMR Washington Covena / Marisa Aragon UMR Administration things you should know Washington Covena / Marisa Aragon - UMR NAH Preferred Networks I 2

3 Presenters Ron Haase Chief Human Resource Officer Northern Arizona Healthcare Washington Covena Director of Account Management - UMR Amy Klawitter VP of Account Management UHC/UMR Dr. Robert Thompson Executive Vice President and Chief Clinical Officer Northern Arizona Healthcare Mary Porter Benefits & HRIS Manager Northern Arizona Healthcare Marisa Aragon Strategic Account Executive UMR Stephanie Villareal Manager Physician Contracting - UHN Dan Benkovich Director Provider Advocacy - UHN Connor Lynch Network Contract Manager - UHN 3

4 UMR, a Third-Party Administrator What s a TPA? UMR is a TPA (Third-Party Administrator) and is hired by employer groups (Clients) to administer and process the plan benefits determined by the client group. TPAs allow for greater flexibility with benefit administration, as well as access to a number of provider networks that fit the needs of the client. For the NAH Employee Benefit Plan we will be accessing the UHC Choice Plus Network. UMR is an affiliate of UnitedHealthcare and is not an insurance company. 4

5 UMR We are the nation s largest TPA! +65 years of experience 4,200+ people focused on your plan 2,000+ customers 3.1 million members 5

6 Dedicated to serving hospitals = Client = Client hospital location United HealthCare Services, Inc.

7 How do medical professionals working with UMR client members access online resources? Go to On your first visit, you will need to register your TIN(s). This website is an efficient way to check claim status, obtain benefits and much more. Please note: This is a different, secure website for UMR client member claim/benefit information. If you are already logged into you will receive a message that the individual is a UMR plan member. The message will include a hotlink to the UMR site, where you will need to sign in. If after three tries the system cannot find the member (possibly because the person is not yet in the UMR database), you will receive a message indicating the member is not found. You should then consult the member s ID card for directions to the correct website. 7

8 Where to submit claims for Northern Arizona Healthcare Employee Benefit Plan? UMR P.O.Box Salt Lake City, UT Electronic Claims should be directed to EDI #

9 Providers, find what you need at umr.com Access your patient information in just a few clicks UMR has made finding claim and benefit information for your patients quick and easy At umr.com, you can view claims and benefit information, including: Explanations of benefits (EOBs) Eligibility and benefit information Status updates on medical deductibles and out-of-pocket maximums 9

10 Viewing member information After you have logged in, you can easily access member information. From mymenu, select Claims or Benefits & coverage for the type of information you would like to view. Enter the member s Social Security number or Member ID in the Member Search box and click Go Select the filter options on the left to expand or refine the claim type and your search time period. 10

11 Need help with umr.com? Contact our technical support team at Click the Provider service center displayed on the bottom of one of the following two locations: 1 2 Benefits > Additional benefits Claims > Claim activity (Note: You must select a specific claim to access the Provider service center) Once you click on the link, you will receive a passcode you can use to contact us by phone and bypass the provider self-service system connecting you with a customer service representative. 11

12 Getting started On umr.com If you already have an account, go to umr.com and enter your username and password in the upper-right corner. First time user, click New user? Register here to open an account. Complete the online registration information. Enter your Tax ID number and provider name. You may view only claims associated with that Tax ID. 12

13 Looking for a form? Here s where to look! Download frequently used forms from the Forms tile on the home page. Need prior authorization for a procedure? Click Get Preauthorization from MyMenu and complete the form. Do not use the site for UMR member Pre Authorization request. Use instead. 13

14 What services will require Notification for UMR clients? Clients with access to UnitedHealthcare Choice Plus follow the standard network requirements for Admission Notification, as well as Advanced Notification per the UnitedHealthcare Administrative Guide. Otherwise, those services requiring prior notification or prior authorization are identified by the member s self-funded benefit plan document. Member penalties may be applicable, for these services, as defined in the plan document for the specific client group. What policies does UMR follow for claims processing, e.g. modifier/bundling edits? UMR follows the same modifier/bundling edits developed by UnitedHealthcare for the Options PPO and Choice Plus products. Please visit to review applicable medical and reimbursement policies for UHC providers. 14

15 How to locate Coverage Determination Guidelines 15

16 Want to set up an electronic funds transfer (EFT) and electronic remittance advices (ERAs)? Make paper checks and remittance advices a thing of the past with electronic funds transfer (EFT) and remittance advice (RA). Enrollment with UMR s Payor ID (39026) is required through Optum at Select the Electronic funds transfer tile on the home page to get started or call the Optum EPS help desk at

17 What is the customer service number for physicians, facilities and other health care professionals to call for eligibility, benefits and follow-up on claim issues? Our Interactive Voice Response (IVR) system number is: Live Provider Representative Monday Friday 8am -5pm (PST): Within a matter of seconds, you will receive a fax with a patient s: Claim status and payment detail Claim status and payment detail. Benefits information Eligibility information. Benefits information Eligibility information Claim submission information Claim submission information Deductible and out-of-pocket status Deductible and out-of-pocket status Prior authorization information Prior authorization information 17

18 IVR System Need eligibility and benefits information? Follow this simple 5-step process: Need eligibility and benefits on multiple patients? It s as easy as 1, 2, 3: 1 2 Press 1 to enter the provider self service IVR Enter and confirm the employee s member ID or Social Security number 1 2 After you hear Your fax is being sent Press 1 3 Enter the patient s date of birth 3 Repeat previous steps 2 through 5 4 Press 1 for eligibility and benefits information 5 Enter and confirm your fax number 18

19 IVR System Need claim status information? Follow this simple 7-step process: Need claim status for multiple claims? It s as easy as 1, 2, 3: Press 1 to enter the provider self service IVR Enter and confirm the employee s member ID or Social Security number Enter the patient s date of birth After you hear Your fax is being sent Press 1 Repeat previous steps 2 through 7 4 Press 2 for claim status 5 Enter and confirm your 9-digit tax identification number (TIN) 6 Enter the date of service (MM/DD/YYYY) 7 Enter and confirm your fax number 19

20 Can physicians complete claim reconsideration requests online? UnitedHealthcare provider appeals can be initiated by NO phone at , or submitted on paper to the UMR United Provider Appeal Unit, P.O. Box Salt Lake City, UT Please Note: When contacting UMR, provide the specific issue, indicating what is expected according to the UnitedHealthcare contract. Allow up to 30 days to receive a response to the reconsideration/adjustment request. Do not allow claim reconsiderations to accumulate or to go unresolved. The contract provides for a limited period to request a reconsideration adjustment. Can customer service agents make claim adjustments over the phone? UMR Customer First representatives (CFRs) can address YES claim issues over the phone, depending on the claim adjustment request. CFRs cannot change a claim, if inappropriate modifiers or CPT/HCPCS codes are listed. Such issues require a resubmission of the claim with corrected codes, from the servicing provider. 20

21 Mobile Web What s new Find out about new tools and information to help you live a healthier life. Simplified navigation Home: Return to the main menu. Menu: Display the menu. Gear: Log out or learn more. Need help? Click the question mark any time you are confused about a term or benefit and get an explanation. Log in Enter your username and password for instant access to all our mobile inquiry tools. Look up claims Look up a claim for yourself or an authorized dependent. Find a provider Need to find a doctor fast? Access an alphabetical listing of network providers. View, scan or fax your ID card View your ID card, allow your provider to scan the on-screen bar code for instant access to your benefit information, and/or fax it to a provider. Deductible and OOP Balances Check your benefits View medical and/or dental benefits, as well as persons covered United HealthCare Services, Inc.

22 Sample ID Card NAH Employee ID Cards 22

23 NAH Employee Plan Preferred Networks Only Available on HDHP 23