United Healthcare Community Delaware Plan Maternity Admission Notification

United. Healthcare Community Delaware Plan

Maternity Admission Notification Update To better serve our provider community, we have streamlined our process in regards to maternity admission notifications: • Please continue to call Intake at 800 -366 -7304 or fax 877 -8230 • The reference number you receive at the time of your initial (maternity admission notification) call or fax is your “authorization” number. • You will only receive a response back to your fax request if you indicate you are using a “Secure Fax” line. • The federal mandates for maternity are automatically approved, two days vaginal and four days cesarean. 2 Proprietary Information of United. Health Group. Do not distribute or reproduce without express permission of United. Health Group.

HEDIS Member Incentive Diabetic Program The State of Delaware has placed a focus on Diabetes care this year. In a effort to increase member compliance, and improve outcomes for our Diabetic members, United. Healthcare Community Plan an diabetic initiative. The member will be rewarded for completing: –DHSS diabetic education course –Diabetic Blood Test –Diabetic Eye Exam 3 Proprietary Information of United. Health Group. Do not distribute or reproduce without express permission of United. Health Group.

Utilization Review- Denial Decision • The treating physician has the right to request a peer-to-peer review • The denial letter contains information • how to request materials • how to contact the reviewer. • Members and practitioners have the right to appeal • Appeals are reviewed by a physician not involved • Appeal request must be submitted within 45 days of the denial. 4 Proprietary Information of United. Health Group. Do not distribute or reproduce without express permission of United. Health Group.

Utilization Review- Denial Decision (Cont. ) Requests should be mailed to: United. Healthcare Community Plan Appeals and Grievances 1001 Brinton Road Pittsburgh, PA 15221 If you have questions about Utilization Management, you can talk to our staff by calling 800 -366 -7304. They are available 24 hrs a day, seven days a week.

Member Rights and Responsibilities Just a reminder! United. Healthcare Community Plan Member Rights and Responsibilities can be found in the Provider Manual. The Provider Manual is located at UHCcommunityplan. com. Member Rights and Responsibilities are distributed to new members upon enrollment and annually thereafter. 6 Proprietary Information of United. Health Group. Do not distribute or reproduce without express permission of United. Health Group.

Important Notice for Delaware Behavioral Health Providers Servicing the Unison Account In partnership with Optum. Health Behavioral Solutions (UBH), the United. Healthcare Community Plan (UHCCP) of Delaware (formerly Unison Health Plan) to assure provider information is accurate contact: For credentialing, demographic updates, or adding a new provider to your practice, please contact UBH at 877 -468 -1031. For claims payment issues, please contact our UHCCP claims service line at 800600 -9007. The Behavioral Health Provider Advocate: Frank Rizzio Network Manager – United. Healthcare Community Plan 100 Penn Square East Suite 400 Philadelphia, PA 1910 215 -231 -3105 Frank. Rizio@optum. com 7 Proprietary Information of United. Health Group. Do not distribute or reproduce without express permission of United. Health Group.

Medical Facts for the State of Delaware - Did You Know? We would like to provide you with some information below that will help your office with questions that may arise in regards to medical facts for the state of Delaware: • Observation level of care is 48 hours for the state of Delaware, not 23 hours. Any physician caring for a United. Healthcare Community Plan member can refer the member for Case Management services. –For more information regarding Case Management, please call Member Services at 877 -8159. • When members have an acute illness and need assistance in the community, please remember that United. Healthcare Community Plan supports Home Health Services for our members. To authorize Home Health Services for a member, please contact Utilization Management at 800 -366 -7304. 8 Proprietary Information of United. Health Group. Do not distribute or reproduce without express permission of United. Health Group.

Primary Care Physician Member Rosters Primary Care Physicians receive a monthly roster of members. The lists are sent to Primary Care Physician offices before the first of every month. New member will have an asterisk (*). Terminated member will have the term date next to them United. Healthcare Community Plan recommends that all Primary Care Physicians and consulting providers verify member eligibility prior to each service. United. Healthcare Community Plan offers eligibility verification by telephone using our Member Eligibility Verification Line, 888 -5864766, contacting Provider Services at 800 -600 - 9007, or via our website at UHCCommunity. Plan. com 9 Proprietary Information of United. Health Group. Do not distribute or reproduce without express permission of United. Health Group.

Fraud, Waste, Abuse Claims Process Updates Fraud, Waste, and Abuse Controls – Prospective Claims Review Effective Aug. 1, 2011, Optum. Insight (formerly known as Ingenix), a United. Health Group company, will become our agent to conduct post-payment reviews to identify and recoverpayments. If an overpayment is identified, Optum. Insight will send a letter to your attention with a list of claims that were paid incorrectly, appeal rights and the contact information of the Recovery Analyst at Optum. Insight handling the overpayment matter. If you have any questions about the overpayment services that Optum. Insight will be performing on behalf of United. Healthcare Community Plan, please call 800 -4142013, choose option 1, between the hours of 8: 00 a. m. to 4: 30 p. m. Central Time. Provider Medical Records can be faxed to: 877 -285 -9063 or mailed to: Optum. Insight Attn: Medical Records PO Box 10567 Atlanta, GA 30348 10 Proprietary Information of United. Health Group. Do not distribute or reproduce without express permission of United. Health Group.

Member Advocates: Here to help YOU! United. Healthcare Community Plan has local Member Advocates available to help the Provider Community with: • Plan members regarding missed appointments • Work with offices regarding coordination of care concerns • Educate members on their rights and responsibilities • Coordinate transportation and access to care services • Help members with pharmacy issues Contact Delaware Member Advocate: Erica Kearse @ 877 -901 -5523. You may also complete our Member Education Request Form that may be found on our site, UHCCommunity. Plan. com and forward via fax.

E-Business Updates United. Healthcare Community Plan Payer ID for Delaware: 25175 In addition to: Electronic claim submission (EDI), Electronic Remittance Advice (ERA) Electronic Funds Transfer (EFT) Now offer: Electronic Eligibility Inquiry Electronic Claim Status Electronic claim submission w/ COB (secondary) To learn more contact: United. Healthcare Community Plan EDI Support Services Phone number: 800 -210 -8315 Email: ac_edi_ops@uhc. com 12 Proprietary Information of United. Health Group. Do not distribute or reproduce without express permission of United. Health Group.

Have you visited UHCCommunity. Plan. com today? Be sure to visit our new website, UHCCommunity. Plan. com, for the most up-to date plan information: • Reimbursement Policies • Bulletins regarding recent policy and procedure changes • Clinical guidelines • Forms and Manuals • Helpful Links • Provider Directory • Local plan contact information

Secure Provider Portal Log on today to: • Verify Patient Eligibility & Benefits • Check Claims Status • Check Appeal Status • Submit an Authorization Go online UHCCommunityplan. com to register an Account: Registration Quick Tips: • Have your United. Healthcare Provider ID and Tax ID numbers ready • Be prepared to set up multiple users if more than one person in your office will be accessing the Web site • Your user ID and password are case-sensitive.

Introducing Diamond State Health Plan Plus (DSHP Plus) to United. Healthcare Community Plan We are pleased to inform you that the Delaware Division of Medicaid and Medical Assistance(DMMA) under the Department of Health and Social Services (DHSS) recently awarded a Managed Long-Term Care (MLTC) plan contract to United. Healthcare Community Plan. This change takes place on April 1, 2012. – Acute care services for MLTC members are covered by feefor-service Medicaid or Medicare. – A care coordinator will work with MLTC members and their medical and long-term care service To learn more about the change visit our website UHCCommunityplan. com 15 Proprietary Information of United. Health Group. Do not distribute or reproduce without express permission of United. Health Group.

Million Hearts Encourage Your Patient’s. To Join the Healthy Heart Fight! http: //millionhearts. hhs. gov/index. shtml What is. Million Hearts. TM? Million Hearts is a national initiative to prevent 1 million heart attacks and strokes over the next five years. Heart disease and stroke are two of the leading causes of death in the United States. Million Hearts brings together communities, health systems, nonprofit organizations, federal agencies, and private-sector partners from across the country to fight heart disease and stroke.