1Oxford Contact Overview. Contact Information at a Glance... 11

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1 1Oxford Contact Overview Contact Information at a Glance

2 Oxford Contact Overview Section

3 Oxford Contact Overview Section 1 Contact Information at a Glance Electronic Solutions To access Oxford s web site, please go to To log in to you will need a user name and password. If you do not have a user name and password, please click on need a user name and password, fill in the required information and submit your request. Providers should have immediate access; facilities will receive a user name and password by telephone within two to three business days. From the provider or facility home page, you can perform the following transactions: Submit and check referrals, claims and precertification requests Submit notification of inpatient admissions (facilities only) Check patient benefits and eligibility Change your address Request materials Perform a provider search Learn about new business arrangements View radiology and laboratory program information View Oxford s prescription drug information View Oxford s medical and administrative policies View Oxford s Clinical and Preventive Practice Guidelines View Oxford s disease management initiatives Oxford Express ( ) Use our automated telephone system to: Check the status of referrals and precertification requests Submit referrals Check the status of claims and request copies of remittance advices Electronic Data Interchange (EDI) Oxford works with various EDI vendors to give our providers an additional option to do electronic business. The EDI vendors and their functions are: Emdeon (formerly WebMD ) Submit referrals and precertification requests Check the status of referrals and precertification requests ProxyMed Submit referrals Check the status of referrals Check claims status Healthcare Data Exchange (HDX) Check the status of precertification requests Athena Check claims status 11

4 Section 1 Oxford Contact Overview Addresses, Telephone and Fax Numbers To access Oxford s Provider Services, which includes Medical Management services, please call (Mon. - Fri., 8 AM - 6 PM). Medical Management Call for Precertification Inpatient admissions Outpatient procedures See section 6 on Ancillary Services for details on precertification for alternative medicine, physical therapy, radiology, or behavioral health; or see section 4 on Precertification for more information. Oxford On-Call The Oxford On-Call program offers flexible choice in healthcare guidance. Members can speak to a registered nurse who can offer suggestions and guidance to the most appropriate source of care, chat online with a nurse about general health questions, or listen to recorded messages on over 1,100 health topics by calling Our registered nurses provide practical self-care tips to help Members manage their condition at home and educate them about signs and symptoms that may indicate the need for a higher level of care. In addition, Oxford On-Call provides Members with helpful information about many topics such as illness, injury, chronic conditions, prevention, healthy living, and men s, women s and children s health. Services and Resources Contact Information Behavioral Health Department Oxford (for precertification only) Fax Clinical Appeals Department fax Complementary & Alternative Medicine fax (care plans) Electronic Solutions Support Fraud Hotline Fraud Hotline Medicare Part D only (may be shared with patients) Laboratory information Laboratory Corporation of America (LabCorp) Client services: Patient service center locator number for Members LabCorp North New Jersey South New Jersey New York Connecticut or See section 6 on Ancillary Services for a complete list of outpatient laboratories. Medicare Appeals Department fax Pharmacy Customer Service (commercial Members) Pharmacy notification (commercial Members) (Mon. - Fri., 8 AM - 9 PM Eastern Standard Time) Pharmacy Customer Service (Medicare Members) Pharmacy precertification (Medicare Members) Physical and Occupational Therapy OrthoNet (commercial members only) Provider services/claim inquiry Medical management Precertification by fax Radiology information CareCore National, LLC (commercial and PREAUTH Medicare radiology) ( ) 12

5 Oxford Contact Overview Section 1 Medicare Customer Service Contact Information Medicare Member Complaints, Appeals and Grievances Department Fax Medicare Member Fraud, Waste and Abuse Complaints Montefiore-CMO arrangement for Medicare Members in Bronx County Medical management/provider services, claim information Referral fax number Pharmacy Customer Service (Medicare Members) Claims Submission Addresses All claims should be submitted electronically through one of the clearinghouses that Oxford works with. Electronic claims should be submitted with Oxford s Payor ID: If mailing in an initial paper claim using the CMS-1500 or UB-92 form, please send the claim to the appropriate address below within 90 days of rendering services: OXFORD IMPORTANT ADDRESSES Commercial and Medicare Claims Oxford Health Plans P.O. Box 7082 Bridgeport, CT Montefiore-CMO Claims Providers participating in a delegated risk agreement for Medicare in Bronx County should submit claims to: Contract Management Organization, LLC Attn: Oxford Claims Department 200 Corporate Drive Yonkers, NY For more information on submitting electronic claims, please call Oxford s Provider esolutions Support Team at

6 Section 1 Oxford Contact Overview Contact Information for Disease and Intensive Case Management Programs Please use the telephone number listed below to contact the specific program coordinator. Active Care Engagement SM (ACE) Better Breathing (asthma) Chronic Obstructive Pulmonary Disease (COPD) Program Depression Program Heart Smart SM programs: Cardiovascular Disease Heart Failure HIV/AIDS Living with Diabetes SM Lyme Program Newborn Critical Care Osteoporosis Program Oxford Cancer Support Program SM Rare Chronic Care Program Transplant Program Information on Anonymous Counseling and HIV Testing Programs Centers for Disease Control (CDC) National AIDS Hotline Connecticut Connecticut Infoline This number is only accessible when calling from Connecticut and provides referrals to all state and local hotlines and resources. New Jersey Available 24 hours, seven days a week, this number is only accessible when calling from New Jersey. New Jersey local number New York New York State and New York City information New York State Spanish/ bi-lingual information New York State TTY/TDD (for hearing-impaired) New York City Department of Health testing hotline Pretesting counseling is conducted over the phone, and appointments are made for callers at testing centers throughout the five boroughs. This service is linked to a crisis intervention hotline. 14