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UnitedHealthcare Provider Portal Resources …

Information and resources for our online self-service tools on the UnitedHealthcare Provider Portal. On the portal you can get member eligibility, benefits, claims and referral information for multiple UnitedHealthcare plans, all in one location.

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The Arizona Health Care Cost Containment System (AHCCCS) has updated its fraud and abuse requirements for health care professionals and subcontractors, effective Oct. 1, 2021. Read Full Article 11/2021: Northeast: Medical PRAs going paperless in February

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Patient Health and Safety UHCprovider.com

Patient Health and Safety. Patient health and safety is an essential and vital component of quality health care. We are one of many stakeholders that supports industry standards to help ensure patient care is safely delivered. We offer physicians and other health care professionals information and tools to help support this important goal.

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Optum ID name changing to One Healthcare ID UHCprovider.com

On the evening of April 9, 2021, Optum ID was re-named One Healthcare ID as part of our digital initiatives, technology updates and migration of UnitedHealthcare services to a new cloud platform.. What this change means for you. Do not use any existing bookmarks to access the log-in page. Previous bookmarks no longer work because of the transition to a new …

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Coding, Submissions & Reimbursement UHCprovider.com

UnitedHealthcare is updating testing guidelines, coding and reimbursement information for the COVID-19 health emergency, based on guidance from the Centers for Medicare & Medicaid Services (CMS), the Centers for Disease Control and Prevention (CDC), state and federal governments and other health agencies. Check back often for updates.

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Optum Pay™ UHCprovider.com

Optum Pay basic and premium modified to better fit your needs. In response to feedback from health care professionals, Optum Pay has modified the benefits available in both the basic and premium portal access levels: For basic access, beginning May 22, 2021, it will include unlimited users for each account.

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Minnesota Health Plans UHCprovider.com

Minnesota Health Plans. UnitedHealthcare provides a range health care alternatives designed to meet the needs of our members. With our broad network of contracted care providers, health care services come from local physicians and hospitals that many plan members know and trust. Not all health care providers in a given state participate in all

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New Jersey Medicare Advantage Health Plans UHCprovider.com

New Jersey Medicare Advantage Health Plans. The following includes a list of the plans available in New Jersey. For more information on a particular plan, click on the plan name. New Jersey AARP® Medicare Advantage Plans. New Jersey Assisted Living Plans. New Jersey Dual Complete® Special Needs Plans. New Jersey Erickson Advantage® Freedom

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UnitedHealthcare Community Plan of New Jersey …

Health Insurance Portability and Accountability Act (HIPAA) Information. HIPAA standardized both medical and non-medical codes across the health care industry and under this federal regulation, local medical service codes must now be replaced with the appropriate Healthcare Common Procedure Coding System (HCPCS) and CPT-4 codes.

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New Jersey Fall/Winter 2019 practicematters

They’ll work with the member’s health care team to help coordinate their care and track any related health issues — all while supporting the relationship and treatment plan set up with the patient’s care provider. The program is voluntary, and members can enroll or disenroll at any time. Share the KRS website and phone number, 866-561-7518,

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Eligibility and Benefits UHCprovider.com

A Better Way to Check Member Eligibility and Benefits. The UnitedHealthcare Provider Portal gives you instant access to the latest eligibility and benefits information in real time without needing to pick up the phone. You can quickly check coverage dates, policy information, detailed benefits information and get a copy of the digital ID card.

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Get to know Bind UHCprovider.com

If you are a health care professional filing a clinical appeal (for prior authorization or other), you can: Mail: UnitedHealthcare Appeals – UHSS, P.O. Box 400046, San Antonio, TX 78229. Fax: 888-615-6584. Phone: 800-808-4424, ext. 15227

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Information for UnitedHealthcare Community Plan Care

Specialty directories for dental, behavioral health, Employee Assistance Program and mental health providers as well as OptumRx pharmacy locators are also available. Members can always find their specific plan information, including in-network care providers, at myuhc.com®.

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Prior Authorization Updates UHCprovider.com

The temporary prior authorization suspensions apply to UnitedHealthcare Medicare Advantage, Medicaid and Individual and Group Market health plan members nationwide, where UnitedHealthcare has health plans available. The suspensions are effective Dec. 18, 2020 through Jan. 31, 2021. State variations and regulations may apply during this time.

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Testing, Treatment, Coding & Reimbursement UHCprovider.com

UnitedHealthcare is updating testing guidelines, coding and reimbursement information for the COVID-19 health emergency, based on guidance from the Centers for Medicare & Medicaid Services (CMS), the Centers for Disease Control and Prevention (CDC), state and federal governments and other health agencies. Check back often for updates.

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Telehealth UHCprovider.com

Depending on a member’s health plan, providers may need to adjust their administrative processes and systems when collecting member cost share (copays, coinsurance and deductibles). To determine if a member has a self-funded plan, please call UnitedHealthcare Provider Services at 877-842-3210.

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Nevada Commercial Health Plans UHCprovider.com

A health savings account (HSA) may be available to pay for qualifying medical expenses, including the annual deductible. The UnitedHealthcare Motion™ program provides a financial reward (in the form of a reimbursement for out-of pocket medical expenses or an HSA deposit) for meeting daily activity goals.

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Electronic Payment Solutions UHCprovider.com

OptumHealth Financial Services, a UnitedHealthcare-affiliated company, provides payment services to the health care industry and offers various claim payment options. UnitedHealthcare-affiliated companies may receive transaction fees or other compensation related to some payment options. The virtual card payment program will exclude KanCare

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Hospital Services (Inpatient and Outpatient)

COVID-19 Public Health Emergency Waivers & Flexibilities: In response to the COVID-19 Public Health Emergency, CMS has updated some guidance for certain hospital services. For a comprehensive list of Coronavirus Waivers & Flexibilities, refer to

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Kansas Commercial Health Plans UHCprovider.com

A health savings account (HSA) may be available to pay for qualifying medical expenses, including the annual deductible. The UnitedHealthcare Motion™ program provides a financial reward (in the form of a reimbursement for out-of pocket medical expenses or an HSA deposit) for meeting daily activity goals.

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Articular Cartilage Defect Repairs

Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws that may require coverage for a specific service. The documentation requirements outnli ed below are used to assess whether the member meets the clinci al criteria for coverage but do not guarantee coverage of the service requested.

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UnitedHealthcare Telehealth Visit Guide

The health care industry is continually discovering new uses for telehealth. Each provider practice will need to decide how telehealth will fit into their clinical model and how it can be used to meet patient needs. Some common examples may include:* PCA-1-20-02221-Clinical-WEB_10202020 7

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Ohio Commercial Health Plans UHCprovider.com

A health savings account (HSA) may be available to pay for qualifying medical expenses, including the annual deductible. The UnitedHealthcare Motion™ program provides a financial reward (in the form of a reimbursement for out-of pocket medical expenses or an HSA deposit) for meeting daily activity goals.

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Durable Medical Equipment, Orthotics, Medical Supplies and

Durable Medical Equipment (DME) is a Covered Health Care Service when the member has a DME benefit, the equipment is ordered by a physician to treat an injury or sickness (illness) and the equipment is not otherwise excluded in the member benefit plan document.

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Pennsylvania Health Plan Support Support by State

Therapeutic Radiation Prior Authorization (IMRT, SRS, and SBRT) (For services to Medicare Advantage Customers only) Phone Number: 800-873-4575. What You Can Do When Calling this Number: Chiropractic, Physical Therapy, Occupational Therapy, and Speech Therapy Providers contracted with OptumHealth Physical Health, a UnitedHealth Group company.

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Coordinating care with behavioral health care

Coordinating care with behavioral health care professionals. Last modified: May 11, 2021. When a member receives services from more than 1 health care professional, it’s important to collaborate to help ensure care is comprehensive and effective. Coordination of care is important for patients, especially those facing severe and persistent

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Ultrasound Diagnostic Procedures (NCD 220.5)

Listing of a code in this guidelinedoes not imply that the service described by the code is a covered or non-covered health service. Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws that may require coverage for a specific service.

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TrackIt UHCprovider.com

Stay in the know – check prior authorizations, referrals, claims status and more. TrackIt allows you to see the status of your recent workflow in the UnitedHealthcare Provider Portal. It lets you know if there are documents you need to upload, missing items that need attention and provides email notification on status updates.

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National Drug Code (NDC) Requirement Policy, Professional

This reimbursement policy applies to all health care services billed on CMS 1500 forms and, when specified, to those billed on UB04 forms. Coding methodology, industry-standard reimbursement logic, regulatory requirements, benefits design and other factors are considered in developing reimbursement policy.

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UnitedHealthcare Compass Plan Overview

UnitedHealthcare Compass is an innovative commercial member benefit plan built on patient-centered health. Members choose a primary care provider (PCP) to help coordinate their care. Compass is offered as an Individual Exchange plan in …

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Practitioner/Provider Administrative Claim Reconsideration

contact the health plan, verbally or in writing, for a review of the claims payment issue. The health plan will make every effort to clarify or explain Oxford’s actions. If the health plan determines that additional payment is justified, Oxford will reprocess the claim and remit the additional payment.

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Obstetrical Ultrasound Policy, Professional

This reimbursement policy applies to services reported using the 1500 Health Insurance Claim Form (a/k/a CMS-1500) or its electronic equivalent or its successor form. This policy applies to all products and all network and non-network physicians and other qualified health care professionals, including, but not limited to, non-network authorized and

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UnitedHealthcare Core Plan Overview

UnitedHealthcare Core Quick reference guide PCA-1-21-02584-E&I-QRG_08112021 UnitedHealthcare Core is an open-access commercial member benefit plan that features a narrow, national network of health care professionals. Key features • Members have access to a national Core network of health care professionals

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2021 2022 Care Provider Manual

the care provider network for all health care services, including medical care and behavioral health services. Instead of navigating two separate networks for medical and behavioral services, members and care providers will have the convenience of a single health plan. This allows the member’s primary care provider (PCP) to

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Rhinoplasty and Other Nasal Surgeries

Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws that may require coverage for a specific service. The documentation requirements outlined below are used to assess whether the member meets the clinical criteria for coverage but do not guarantee coverage of the service requested.

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Sodium Hyaluronate – Commercial Medical Benefit Drug Policy

Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws that may require coverage for a specific service. The documentation requirements outlined below are used to assess whether the member meets the clinical criteria for coverage but do not guarantee coverage of the service requested.

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Credentialing and Recredentialing for Health Care

The credentialing process is the health care industry standard to collect and verify each health care professional’s qualifications. Why is credentialing important? Credentialing assesses qualifications, relevant training, licensure, certification and/or registration to …

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2021 UnitedHealthcare Care Provider Administrative Guide

workers’ compensation or other government programs. “Commercial” also applies to benefit plans for the Health Insurance Marketplace, government employees or students at public universities. • “You,” “your” or “provider” refers to any health care provider subject to this guide. This includes physicians, health care

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Maine Health Plan Support Support by State

United Behavioral Health - ProviderExpress.com For information to support member behavioral health services including depression, alcohol and substance abuse disorders, visit ProviderExpress.com 866.342.6892 - 24/7 mental health and substance use support line

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Hyperbaric Oxygen Therapy – Medicare Advantage Coverage

information in making health care decisions. Physicians and patients must exercise their independent clinical discretion and judgment in determining care. Each benefit plan contains its own specific provisions for coverage, limitations, and exclusions as stated in the Member’s Evidence of Coverage (EOC)/Summary of Benefits (SB).

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Prior authorization requirements for North Carolina Medicaid

health care providers must request prior authorization for all procedures and services, excluding emergent or urgent care. Prior authorization is the process where health care providers seek approval before rendering a service, as required by UnitedHealthcare policy. It’s required under the direction of the UnitedHealthcare Health Services

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Community Plan Care Provider Manuals for Medicaid Plans By

The UnitedHealthcare Community Plan of Kansas Physician, Health Care Professional, Facility and Ancillary Care Provider Manual applies to the following plans: UnitedHealthcare Community Plan of Kansas - KanCare. The UnitedHealthcare Community Plan Care Provider Administrative Guide has been approved by the State of Kansas.

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Prostate Cancer Physician Worksheet

Health Plan: Member ID: Clinical Information. ICD-10 Code(s): What is the radiation therapy treatment start date (mm/dd/yyyy)? Please have the answers to below questions prepared as these questions may be asked. Is radiation being delivered as:

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Diabetes Supply Coverage

prescribed by a health care professional licensed to prescribe such items. Coverage is provided for these items regardless of whether the members specific benefit plan provides DME, medicalsupply or pharmacy coverage. All members, including NJ Small and Large groups, may pay out-of-pocket for their supplies and submit a receipt, noting the

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UnitedHealthcare NexusACO

Health plan coverage provided by UnitedHealthcare of Arizona, Inc., UHC of California DBA UnitedHealthcare of California, UnitedHealthcare Benefits Plan of Cali fornia, UnitedHealthcare of Colorado, Inc., UnitedHealthcare of the Mid-Atlantic, Inc., MAMSI Life and Health Insurance Company, UnitedHealthcare of New York, Inc.,

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Claims disputes and appeals

The health care provider must submit a payment dispute within 120 calendar days from the date of the original claim determination. At a minimum, the delegate must have the following requirements and processes in place when handling claim payment disputes with an MA non-contracted health care provider:

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Transcranial Magnetic Stimulation – Commercial Medical Policy

Listing of a code in this policy does not imply that the service described by the code is a covered or non- covered health service. Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws that may require coverage for a specific service.

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