Provider Service Model Collaborating for Success Jodi Stockslager, Sr. Provider Advocate, Provider Relations
Agenda Welcome / Introductions UnitedHealthcare overview Member ID Cards Products and networks Optum programs Self service tools and resources Your provider relations team Working together
National Expertise, Midwestern Know-How Bringing innovative approaches, products and services to address the biggest challenges in health care today with an aim toward improving: Care experiences UnitedHealthcare provides care coverage and benefits services. Optum provides information and technology-enabled health services. Health outcomes Overall cost of care Foundational competencies Clinical Insight Knowledge and experience in organizing health care resources to best serve specific local market needs Technology Enabling a variety of interactions at enormous scale and complexity, helping connect all participants in health care Data and Information Unique skills in collecting, managing and analyzing data; and the capability to translate data into actionable information Serving 139 million unique individuals globally across all businesses 3
A Better Health Care Experience Comes Home This year, UnitedHealthcare will begin selling health plans in Minnesota (MN), North Dakota (ND) and South Dakota (SD), with the goal of: Building a local provider network to deliver quality care experiences to members in these states Offering plans to: Mid-size employers in September 2018 Small employers and Medicare starting in January 2019 Providing additional competition in the form of greater choice and more innovative solutions 4
What changed on September 1, 2018? Approximately 219,000 UnitedHealthcare members in MN, ND, SD & western WI who previously accessed the LaborCare network gained access to the UnitedHealthcare Choice/Choice Plus network. Group numbers, ID cards and payer ID s did not change. Care provider contractual terms and rates changed based on individual contracts. Some cards may still have the LaborCare logo on the back. These can be disregarded after 9/1/18. Payer ID remains: 87726 5
What changes on or after January 1, 2018? Approximately 215,000 large group members accessing the Medica Choice Passport network today will begin to transition to UnitedHealthcare network on January 1, 2019 or upon renewal of group contracts. ID cards and payer IDs will change for these members upon renewal. Prior to 1/1/19 or upon policy renewal Payer ID: 94265 After 1/1/19 or upon policy renewal Payer ID: 87726 6
MN Commercial Product Offerings Administrative Services Only (ASO) 7
UnitedHealthcare Networks Network Contracting Build and manage many different networks across Commercial, Medicare, Medicaid business 4 regional teams (Northeast, Southeast, Central & West) Value-based and Accountable Care Organization (ACO) contracting Provider Advocates Directly manage care provider relationships through training, issue resolution and listening to how UnitedHealthcare can improve the provider experience. 8
UnitedHealthcare Networks, cont. National Ancillary Strategy and Contracting Develop strategy and manage program specialties for ancillary services, including: Convenience Care Clinics Dialysis Durable Medical Equipment Home Health Home Sleep Testing Hospice Lab Transportation Non-Emergent Urgent Care Vaccine/ Wellness Virtual Visits Pharmacy programs Set strategy and direction to create affordable pharmacy benefits for our commercial and Medicaid customers and consumers. Several other functions support the provider networks, including analytics, network operations and support, strategic account management. 9
Optum Behavioral Health What we do Manages one of the largest behavioral health networks in the country with more than 166,000 active network providers. This includes contracting, credentialing, and demographics. Need help? Optum Behavioral Health Provider Service Center: (877) 614-0484 Optum Provider Express Provider Portal www.providerexpress.com Minnesota Network Management Team Wendy Montoya Olga Ponomarev Network Manager Network Associate wendy.montoya@optum.com olga.ponomarev@optum.com Steve Inzerello Senior Network Manager steve.inzerello@uhc.com 10
Optum Physical Health What we do Maintains network of physical, occupational, and speech therapy and chiropractor practitioners for the UnitedHealthcare membership to access under various health plans and networks. Provide clinical review on PT/OT services for the UnitedHealthcare s fully insured clients, as well as self-insured clients who add the Optum Clinical Submission Process to their benefit plan. Need help? First contact UnitedHealthcare at 877-842-3210. Call Optum Provider Services at 800-873-4575 if: a problem remains unresolved after 30-days you have questions related to credentialing, demographic changes, fee schedule, or anything related to contract set-up. Optum Provider Portal myoptumhealthphysicalhealth.com 11
Optum Complex Care What we do Contract for skilled services as well as outpatient therapy provided at the skilled nursing facility. Provider relations team interacts with care providers in person and via phone/email. Need help? Contact Molly Gagan at molly.gagan@optum.com or 952-205-2255. 12
Making it Easier to Work With Us Our provider service model includes tools and resources that support a better provider experience. Self-service tools, including the Link portal and a new provider website, to make it quick and easy for you to access the information you need Call center support to help you address concerns, answer questions and connect you to available resources Provider Relations Team based locally to proactively communicate, resolve issues and support care providers in working effectively with UnitedHealthcare
Access to Information Online, Anytime Our new provider website UHCprovider.com makes it easier to find the information you need. Easily search for information. Quickly find administrative guides, policies and protocols. Instantly access the most-used transactions and information. Stay current with the newest developments from UnitedHealthcare and Optum.
Getting Started 15
Quick-Start Guide www.uhcprovider.com/gettingstarted 16
Link Self Service Tools Connecting you to the tools you need to manage UnitedHealthcare member accounts.
Powerful Apps Put the Information You Need In One Place Link apps are online tools that give you the comprehensive information you need quickly without the extra step of making a phone call. Get eligibility and benefits details Submit requests Manage claims Get prescription coverage detail
UHC On Air Live and on-demand video broadcasts keep you informed Learn about national and local topics. Discover new UnitedHealthcare programs and quality initiatives. Access tips and training for online tools. Receive up-to-date operational and clinical policy information. And more.
Sign up for UnitedHealthcare Updates The Network Bulletin is published monthly. To sign up for the Network Bulletin and other UnitedHealthcare communications, click on Menu in the upper left hand corner of www.uhcprovider.com/news > Network Bulletin > Sign up to receive Network Bulletin. 20
Provider Advocates Education and Training Train and onboard new groups, staff Support with self-service tools Provide access to performance data Keep you informed about new UnitedHealthcare initiatives Personalized Service Listen to your challenges and opportunities Engage the appropriate UnitedHealth Group contacts, when needed Escalate unresolved claims issues Document, report and resolve administrative issues Expert Guidance Understand the tools and tactics to help simplify your administrative process. Offer insight and additional resources on issues that impact your organization.
Local Call Center 1-877-842-3210 Hours of operation: 7 AM to 7PM CT The provider service center will be co-located with the MN/ND/SD Network and Provider Relations team in Minnetonka, MN. Operational leadership will meet with Provider Services weekly to review service opportunities and develop follow up action plans. 20 provider call center representatives recently completed a 16-week training. Additional staffing will be added Q4 2018.
Contact Us Provider Service Center 877-842-3210 Provider Network Management 866-569-2069 sd_contracting@uhc.com Provider Relations sd_provider_relations@uhc.com 23
We are listening Administrative Advisory Council: Health care leaders who represent a cross-section of the local network are invited to participate on the Council for a year. The group meets quarterly to provide feedback and input on working with UnitedHealthcare. Surveys: Marketplace/Competitive, loyalty/relationship, satisfaction with specific points in the experience Closing the Loop Healthcare Executive Advisory Council (HEAC) Healthcare Technology Advisory Council Industry association meetings: South Dakota Medical Association, South Dakota Medical Group Management Association 24
Resources Laboratory Policy: Commercial: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/commreimbursement/comm-laboratory-services-policy.pdf M&R: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/medadvreimbursement/medadv-laboratory-services-policy.pdf Policy for Billing for Lab Supplies, Splints and Braces POS 12: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/commreimbursement/comm-dme-orthotics-prosthetics-multiple-frequency-policy.pdf SL modifier for VFC Vaccines: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/commmedical-drug/vaccines.pdf 25
Questions?
Thank you! Insurance coverage provided by or through UnitedHealthcare Insurance Company, All Savers Insurance Company, Oxford Health Insurance, Inc. or their affiliates. Health Plan coverage provided by UnitedHealthcare of Arizona, Inc., UHC of California DBA UnitedHealthcare of California, UnitedHealthcare Benefits Plan of California, UnitedHealthcare of Colorado, Inc., UnitedHealthcare of Oklahoma, Inc., UnitedHealthcare of Oregon, Inc., UnitedHealthcare of Texas, LLC, UnitedHealthcare Benefits of Texas, Inc., UnitedHealthcare of Utah, Inc. and UnitedHealthcare of Washington, Inc., Oxford Health Plans (NJ), Inc. and Oxford Health Plans (CT), Inc. or other affiliates. Administrative services provided by United HealthCare Services, Inc., OptumRx, OptumHealth Care Solutions, LLC, Oxford Health Plans LLC or their affiliates. Behavioral health products are provided by U.S. Behavioral Health Plan, California (USBHPC), United Behavioral Health (UBH) or its affiliates. Doc#: PCA-1-011516-07242018 2018 United HealthCare Services, Inc.