Common Questions and New Updates

Transcription

1 Common Questions and New Updates Nov. 19, 2015 Kelley Kaminski, Network Account Manager Kim Marsh, Provider Advocate

2 Agenda Credentialing compared to Contracting Roster maintenance National Disclosure Forms Essential Plan Medical Policy Updates ICD-10 Optum Cloud Dashboard is now Link For more information UnitedHealthcare contacts Doc#: PCA _

3 Credentialing Before participation agreements can be finalized, care providers applications must be approved by our national credentialing center Ensure your information with CAQH.org is updated and you have authorized UnitedHealthcare access to access your information Physician groups should contact our national credentialing center to verify/report if physicians within your organization are credentialed with us in New York State Send a completed request for participation form with W-9 by fax to Doc#: PCA _

4 Contracting Once credentialing is completed, contact your UnitedHealthcare network account manager to verify a participation agreement is being sent to you. A participation agreement signed by both parties with an effective date must be on file to be a participating care provider. The effective date is the first day of the first calendar month that begins at least 30 days after the date when the agreement has been executed by both parties. A care provider is not part of our network until both the credentialing and contracting processes are completed. 4 Doc#: PCA _

5 Roster Maintenance Roster Audit Rosters include a listing of physicians in the practice Keeps information accurate for directories, member inquiries, incentive programs, etc. Steps to a Clean Roster Complete a roster tracker using our template, which you can obtain from network management. UnitedHealthcare will compare your roster to the information we have in our system. We will report findings and make any needed corrections. Notify UnitedHealthcare when a care provider leaves your practice, or changes practice location. 5 Doc#: PCA _

6 National Disclosure Forms Requirements The Centers for Medicare and Medicaid Services (CMS) requires each state to monitor funds paid to care providers who participate in statebased health care programs, such as Medicaid and CHIP. UnitedHealthcare Community Plan is required by New York State to obtain a completed national disclosure form every three years from each participating care provider. Disclosure information must be updated within 35 days of information changes, and at least every three years. Care providers must disclose the information requested on the form prior to participation in the network. This year forms are due by Dec. 31, Action Required Care providers without updated disclosure forms on file may experience a disruption in claims payments. Contact your network manager, or find the form on UnitedHealthcareOnline.com and return it to us online, by , fax or in the mail before Dec. 31, Doc#: PCA _

7 Essential Plan Health plan in New York Essential Plan is a Qualified Health Plan offered by UnitedHealthcare in several counties of New York For lower-income individuals who make more than the Medicaid eligibility threshold, but less than 200 percent of the poverty level Care provider contracts are being amended to add Essential Plan for all providers that participate with UnitedHealthcare Community Plan Open Enrollment began on Nov. 1, 2015 Coverage begins Jan Doc#: PCA _

8 Medical Policy Update Bulletin 8

9 ICD-10 9

10 Link Link replaces Optum Cloud Dashboard Care providers and administrative staff have told us they want a better way to get the information they need to check benefits and eligibility, determine claim status, submit claim reconsiderations and more. Link includes many of the same applications as Optum Cloud Dashboard, but with a new interface that can help make your work measurably faster and easier.* Link was created to support the way you work; based on feedback from users who may face the challenges you face. Quickly move between apps, and even customize your screen to put your most common tasks just one click away. *Based on ongoing usability studies using keystroke-level modeling when comparing Link to UnitedHealthcareOnline.com and Optum Cloud Dashboard. 10Doc#: PCA _

11 Link 11Doc#: PCA _

12 UnitedHealthcareOnline.com UnitedHealthcareOnline.com is the access point for Link. Sign-in using your Optum ID. See the October 2015 Network Bulletin for more information about Link, obtaining your Optum ID and internet browser requirements. 12Doc#: PCA _

13 UnitedHealthcareOnline.com 13Doc#: PCA _

14 For more information Network Bulletin monthly publication, found at UnitedHealthcareOnline.com > Tools & Resources > News & Network Bulletin Town hall meetings held quarterly on various topics Third Wednesday of every month, 11:00 a.m., ET Meeting Number: Password: UHC Audio conference information: To join the online meeting, go to: &PW=NM2YwZDZkZDA1&RT=MiMxMQ%3D%3D Notification Changes UnitedHealthcareOnline.com > Clinician Resources > Advance and Admission > Notification Requirements 14Doc#: PCA _

15 Notification Changes 15 Doc#: PCA _

16 UnitedHealthcare Contacts Network Management Network Management Available to all hospitals, physicians and physician groups Hospital: Physician: Network Director: Doc#: PCA _

17 UnitedHealthcare Contacts Provider Advocates Facility and Provider Advocates Available to all hospitals, physicians and physician groups Provider Advocate: or Provider Relations Manager: Doc#: PCA _

18 Questions? Thank you. Proprietary 18 Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group. Doc#: PCA _ Doc#: PCA _