2018 Quick Reference Guide SAN ANTONIO

Transcription

1 Effective: Amerivantage Classic Select + RX (HMO): H Cigna-HealthSpring Preferred (HMO): H AARP MedicareComplete SecureHorizons (HMO): H Amerivantage Classic + RX (HMO): H Cigna-HealthSpring TotalCare (HMO SNP): H UnitedHealthcare Dual Complete (HMO SNP): H Amerivantage Dual Coordination (HMO SNP): H AARP MedicareComplete SecureHorizons Essential (HMO): H CHIROPRACTIC Contracted Network Contracted Network Contracted Network CONTRACTING contracthelpdesk@wellmed.net Fax: COMPLIANCE Fraud & Abuse Hotline: Compliance Officer: compliance@wellmed.net Secure CLAIMS ADDRESS Clearinghouse: Optum Insight Routing #: WELM2 contracthelpdesk@wellmed.net Fax: Fraud & Abuse Hotline: Compliance Officer: compliance@wellmed.net Secure Clearinghouse: Optum Insight Routing #: WELM2 UnitedHealthcare Chronic Complete (HMO SNP): H contracthelpdesk@wellmed.net Fax: Fraud & Abuse Hotline: Compliance Officer: compliance@wellmed.net Secure Clearinghouse: Optum Insight Routing #: WELM2 WellMed Networks Inc. Claims Department P.O. Box San Antonio, TX WellMed Networks Inc. Claims Department P.O. Box San Antonio, TX WellMed Networks Inc. Claims Department P.O. Box San Antonio, TX Claims status can be viewed at: Claims status can be viewed at: Claims status can be viewed at: DENTAL DentaQuest: DentaQuest: UnitedHealthcare Dental: Varies by Benefit Plan DIABETIC SUPPLIES DIAGNOSTIC / ADVANCED RADIOLOGY diabeticsupplyteam@wellmed.net Phone: Fax: EviCore Phone: diabeticsupplyteam@wellmed.net Phone: Fax: EviCore Phone: diabeticsupplyteam@wellmed.net Phone: Fax: EviCore Phone: of 6

2 Effective: Amerigroup Cigna-HealthSpring UnitedHealthcare HEARING Amerigroup s Dedicated Service Unit: Hearing Care Solutions: Benefit Plan: H EPIC: Benefit Plans: H , H and H hi HealthInnovations: LABORATORY LabCorp: LabCorp: LabCorp: BEHAVIORAL HEALTH PHARMACY (Drug Inquiries) PHARMACY (Mail Order) PRIOR AUTHORIZATION Amerigroup: Dawn Turner, Sr. Behavioral Health Case Manager: Ext Express Scripts Inc. (ESI): Customer Service: ESI PA: Phone: Fax: Express Scripts Inc. (ESI): Customer Service: ESI PA: Phone: Fax: WellMed Utilization Management: eprg: Phone: Fax: Cigna-HealthSpring Behavioral Health Services: Phone: Fax: Catamaran: Cigna-HealthSpring Home Delivery Pharmacy: Fax: Catamaran Home Delivery Pharmacy: Phone: Fax: Walgreens Mail Service Pharmacy: Phone: Fax: Walmart Home Delivery Pharmacy: Phone: Fax: WellMed Utilization Management: eprg: Phone: Fax: OptumHealth Behavioral Solutions: Medicare Advantage: Special Needs Plan: OptumRx: Oral Drugs Prior Authorization: Phone: , option 1 Fax: Injectable Drugs Prior Authorization: Phone: , option 2 Fax: OptumRx: Oral Drugs Prior Authorization: Phone: , option 1 Fax: Injectable Drugs Prior Authorization: Phone: , option 2 Fax: WellMed Utilization Management: eprg: Phone: Fax: SECURE PROVIDER PORTAL eprg: eprg: eprg: 2 of 6

3 Effective: Amerigroup Cigna-HealthSpring UnitedHealthcare TRANSPORTATION Access2Care: Benefit Plan Limits Apply; Schedule 24 hours in advance or Logisticare Solutions: Benefit limits may apply; Schedule 2 business days in advance VISION (Exam/Hardware) Block Vision: Member Services: Provider Services: IVR Members: Providers: TTY: Access2Care: Benefit Plan Limits Apply; Schedule 2 business days in advance Only for Benefit Plan: H Superior Vision: Comfort Care: Benefit Plan Limits Apply; Schedule 3 days in advance Applies to all Benefit Plans WellMed Contracted Network VISION (Ophthalmology) Contracted Network Contracted Network WellMed Contracted Network PROVIDER RELATIONS WellMed - San Antonio Office: PCPs: Specialists/Ancillary: WellMed - San Antonio Office: PCPs: Specialists/Ancillary: WellMed - San Antonio Office: PCPs: Specialists/Ancillary: of 6

4 Amerivantage Select + RX (HMO): H Quick Reference Guide SAN ANTONIO SAMPLE MEMBER ID CARDS Amerivantage Classic + RX (HMO): H Amerivantage Dual Coordination (HMO SNP): H The member ID cards represented on this page are sample ID cards. Please refer to the patient s actual ID card for the most accurate information. 4 of 6

5 Cigna-HealthSpring Preferred (HMO): H SAMPLE MEMBER ID CARDS Cigna-HealthSpring TotalCare (HMO SNP): H Correct Plan Number: H Correct Plan Number: H AARP MedicareComplete SecureHorizons (HMO): H Correct Claims Address: PO Box San Antonio, TX WellMed s EDI Routing or Payor ID: WELM2 For Providers: UnitedHealthcare Dual Complete (HMO SNP): H The member ID cards represented on this page are sample ID cards. Please refer to the patient s actual ID card for the most accurate information. 5 of 6

6 AARP MedicareComplete SecureHorizons Essential (HMO): H Quick Reference Guide SAN ANTONIO SAMPLE MEMBER ID CARDS Correct Claims Address: PO Box San Antonio, TX WellMed s EDI Routing or Payor ID: WELM2 For Providers: UnitedHealthcare Chronic Complete (HMO SNP): H Correct Claims Address: PO Box San Antonio, TX WellMed s EDI Routing or Payor ID: WELM2 For Providers: The member ID cards represented on this page are sample ID cards. Please refer to the patient s actual ID card for the most accurate information. 6 of 6