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Provider Relations September 2014

Provider Relations September 2014. Physician Advocates & Network Management Reconsideration versus Appeal Notifications/Prior Authorizations Optum Cloud ICD-10 Updates Contact Information Questions. Agenda. Advocates & Network Management. What is a Physician Advocate?. .

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Provider Relations September 2014

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  1. Provider RelationsSeptember 2014

  2. Physician Advocates & Network Management Reconsideration versus Appeal Notifications/Prior Authorizations Optum Cloud ICD-10 Updates Contact Information Questions Agenda Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

  3. Advocates & Network Management

  4. What is a Physician Advocate?  • A UnitedHealthcare navigational specialist • Product expert, represents all • Externally focused – interacts with the physicians and has a direct line of sight to the challenges experienced by local practices. • Relationship manager – builds collaborative working relationships and communicates changes to physicians in a timely way United Healthcare   Physician Advocate Office Staff Physicians  Responsive, Proactive, Reliable and Simplistic!

  5. Network Account Management • Contract negotiations and management • Contract interpretation questions • Fee schedule inquiries • Product offerings and amendments Your Partner for Contract Needs To find your Network Account Manager www.unitedhealthcareonline.com > Contact Us > Select “Nebraska”

  6. Reconsiderations versus Formal Appeals

  7. Reconsideration vs. Appeal Step 1: Claim Reconsideration Step 2: Claim Appeal Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

  8. Prior Authorization/Notifications

  9. Notifications/Prior Authorizations • Referral Submission • Referral Status • Notification/Prior Authorization Required Inquiry • Notification/Prior Authorization Status • Notification/Prior Authorization Submission • Radiology Notification & Authorization • Submission & Status • Radiology Notification • Submission & Status • OptumRx Prior Authorization • Submission & Status • Specialty Drug Prior Authorization • Submission & Status • Cardiology Notification & Authorization • Submission & Status Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

  10. Optum Cloud Resources Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

  11. Optum Cloud Dashboard The Next Evolution of our online tools is here. Join us on the Optum Cloud Dashboard Optum Cloud Dashboard is a cloud-based* website where UnitedHealthcare will add new features and functionality for physicians and health care professionals. NOW AVAILABLE: The Claim Reconsideration with Attachments application (app) is available for these lines of business: UnitedHealthcare Commercial, Medicare Solutions, Oxford, UnitedHealthcare West, and UnitedHealthcare Community Plan**. Please continue to follow your existing process for claim reconsiderations that do not require attachments.UnitedHealthcareOnline.com Password Owners and ID Administrators can register from the User ID & Password Management page and then initiate the registration process for Standard Users, who will receive an email invitation to complete the registration process. . *Cloud computing refers to shared resources and information housed in a “cloud” on the internet that you can securely access from your web browser from any internet connection. Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group. 11

  12. Optum Cloud Dashboard There are a few things you can do now to prepare for the Optum Cloud Dashboard: Everyone who registers for the Optum Cloud Dashboard must have a unique email address. If you currently share an email address with other UnitedHealthcareOnline.com users, please create your own email and then login to update the My Account page. If you currently share a User ID with another UnitedHealthcareOnline.com user, we encourage you to set up your own User ID now. If you use a browser version lower than Internet Explorer 8, Firefox 10 or Safari 5, consider updating to a higher version for best viewing and make sure that JavaScript is enabled. Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group. 12

  13. Optum Cloud Dashboard Registration: 3rd Wednesday of every month (Q&A afterward)  Optum Cloud Dashboard Applications* (Claims Reconsideration, Eligibility & Benefits Center and Claims Management) Every Wednesday & Thursday of each week Optum Cloud Dashboard Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group. 13 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

  14. ICD-10 Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

  15. UnitedHealthcare’s ICD-10 Website Website • UnitedHealthcare’s ICD-10 website allows our • delivery-side partners to receive information when they need it. • Go to: www.unitedhealthcareonline.com • It provides access to: • Education • On-demand education module and PowerPoint presentations • Tools • ICD-10 Code Decision Trees • ICD-10 Code Look Up Tool • Resources • ICD-10 focused website links • Partnerships—including low cost offerings such as: • AAPC discounts on ICD-10 Education @ www.aapc.com/uhc • Optum ICD-10 Self Assessment Toolkit click here Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group. UHC2231l_20130611

  16. ICD-10 Assistance? • ICD-10 Questions can be sent to: • Icd10questions@uhc.com • Aaron R. Sapp • National ICD-10 Program Director • 303-984-1897 • aaron.sapp@uhc.com Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group. • UHC2231l_20130611

  17. Updates Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

  18. Delay of New Outpatient and Professional Therapy Functional Reporting Requirement Prior Authorization Requirement for Outpatient Injectable Discontinuation of the ANN Form and Changes to the Charging Customers for Non-covered Services Protocol Electronic Payments & Statements is Expanding UnitedHealthcare’s Medicare Advantage Part B Specialty Drug Prior Authorization Program Terminated September Network Bulletin Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

  19. UnitedHealthcare Provider Relations and Service Team • Your Partner for • Claims and Service Needs: nebraska_pr_team@uhc.com • Navigational specialist • One contact for all UnitedHealth Group companies • Assistance with education; self-service tools • Help with service issues • Works to maximize the ability of practices to interact with UnitedHealthcare

  20. Questions? Thank you for attending!

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