UnitedHealthcareOnline Presentation

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NEBRASKA Spring AAHAM

Confidential property of UnitedHealth Group. Do
not distribute or reproduce without the express
permission of UnitedHealth Group.
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• Whats New in
• Nebraska

UHC0048_061009
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TODAYS AGENDA INCLUDES

• ICD-10
• Optum Cloud
• Advance Notification Contact Info
• Enhanced HIPAA Edits
• PATH Member Rewards
• Advocate Hotline
• United Healthcare Military Veterans/TRICARE
• QA

UHC0048_061009
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ICD-10 On Hold

• To support our providers during this transition,
  UnitedHealthcare offers the following tools at
  UnitedHealthcareOnline.com to assist you in
  becoming ICD-10 compliant for 2015
• ICD-10 Education - on-demand educational
  resources designed to provide general
  information regarding ICD-10 and the
  implementation process.
• ICD-10 Tools - in collaboration with the
  American Academy of Professional Coders (AAPC),
  the largest coding organization in the country,
  we have created a suite of tools including
  ICD- 10 code selection decision trees and
  detailed clinical documentation improvement
  webinars.
• Submit questions to ICD10Questions_at_uhc.com.
  Please allow up to15 business days for a
  response.
• Additional resources can be found on
  cms.gov/ICD10.

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OPTUM CLOUD DASHBOARD

• Optum Cloud Dashboard - Is a cloud-based website
  that has new features and functionality which
  allows providers to submit claim reconsideration
  requests electronically with attachments.
• New Enhancements
• The Eligibility Benefits center- check
  eligibility, get in and out of network benefit
  info, review coordination of benefits info and
  review copay and coinsurance
• Claims Management- flag claims for automatic
  review and view line level and claim level remark
  codes

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ADVANCE NOTIFICATION LIST

• Advance Notification List - The Advance
  Notification list of procedure codes has moved
  online for your convenience at UnitedHealthcare
  Online.com Clinician Resources gt Advance
  Admission Notification Requirements.

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Enhanced HIPAA Edits to be Applied to Claim
Submissions

• Effective April 23, 2014, UnitedHealthcare will
  apply an enhanced level of HIPAA edits to
  professional (837p) and institutional (837i)
  claims submitted electronically to most
  UnitedHealthcare and affiliate payer IDs.
• Because the new edits will be applied on a
  pre-adjudication basis, an increase in the number
  of claim rejections may occur. This will enable
  you to identify and correct rejected information
  prior to the claims acceptance into our
  adjudication system for processing.
• The benefit will be fewer denied claims and less
  interruption to revenue streams.
• The primary impact to you will come from edits
  that will validate code sets (such as diagnosis,
  procedure modifier and national drug codes) at a
  pre-adjudication level.
• The complete list of enhanced edits has been
  distributed to clearinghouses and software
  vendors.

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• Contact Us
• Nebraska_PR_team_at_UHC.com
• UnitedHealthcareonline.com

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• TRICARE Updates
• UnitedHealthcare Military Veterans

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• Updated Provider Handbook
• The UnitedHealthcare Military Veterans TRICARE
  Provider Handbook has been updated and the new
  edition is available online at www.uhcmilitarywest
  .com.
• The changes in the Handbook will be effective on
  July 1, 2014 for currently contracted providers
  and immediately for providers newly contracted on
  or after April 1, 2014.
• A summary list of changes to the Handbook has
  also been posted for your convenience.

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Submit Referrals/Authorization Online

• To Submit a Referral or Authorization Request
• Log in to your UHCMilitaryWest.com account.
• From the authenticated Provider Home Page, click
  on the Submit Referral or Authorization Request
  link.
• Updates include selecting Episodes of Care and
  adding attachments
• Only UnitedHealthcare Military Veterans
  in-network, and TRICARE-contracted providers
  with a UHCMilitaryWest.com account, can submit
  referrals or authorizations online.

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• Prior Authorization Changes
• Changes to the PAL
• Durable Medical Equipment over 150
• Orthotics
• Prosthetics
• Questionable Services List
• List of Codes Removed
• The list of codes requiring Prior Authorization
  has been removed as it was not a comprehensive
  list
• Please utilize the narrative Prior Authorization
  List and also reference the of Questionable
  Services List to determine what requires Prior
  Authorization

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DME Authorization Requirements

• Pricing Criteria
• Authorization needed for all Durable Medical
  Equipment (DME) greater than 150.00
• DME Tip Sheet
• A detailed DME tip sheet can be found on
  www.uhcmilitarywest.com Providers gt Claims gt
  Durable Medical Equipment Claims Filing Tip Sheet
• REQUIRED ITEMS which must be on all DME
  authorization requests
• patients name
• procedure code(s)
• diagnosis code(s)
• beginning and ending dates equipment is needed
• physicians statement of prognosis
• valid physician signature not certified NP or
  PA

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DME Authorization Requirements

• Authorizations satisfy Certification of Medical
  Necessity (CMN) requirements if DME item costs
  150 - 2000
• Exceptions five (5) items require additional
  clinical information through submission of the
  appropriate CMS form http//www.cms.gov/Medicare
  /CMS-Forms/CMS-Forms/CMS-Forms-List.html
• Proof of Medical Necessity is required for
  authorization if DME item costs over 2000
• Be sure to include
• required item list (patient name, diagnosis
  codes, procedure codes, etc.) and
• supporting clinical information justifying the
  need

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DME Upgrades

• DME upgrade is covered when medically necessary
• Item otherwise meets the DME benefit requirement
• Medically necessary
• Prescription specifically states the medical
  reason why upgrade is necessary
• (ex the beneficiary does not have the physical
  strength or balance required to lift a standard
  walker and, therefore, one with wheels is
  required)
• DME upgrade for deluxe, luxury, or immaterial
  feature device when beneficiary preference (not
  medically necessary)
• TRICARE-allowed amount for base model may be
  applied to the upgraded equipment if item
  otherwise meets the DME benefit requirement
• The beneficiary will be solely responsible for
  the difference between the base model (standard
  equipment) allowed amount and providers billed
  charges.
• Upgrade must be within the range of services that
  are appropriate for the medical condition
• When a beneficiary prefers to upgrade
• Provider may collect charges that exceed the cost
  the government would pay for the standard
  equipment only when
• Beneficiary given written notice the upgrade has
  been (or may be) denied and
• Beneficiary agrees in writing to be financially
  liable for the difference between charges for the
  upgraded item and the charges for the standard
  item.

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PGBAs Website myTRICARE.com

• myTRICARE.com Functionality
• Verify Eligibility (including PCM, program,
  deductible, and OHI information)
• Check Referral/Authorization Status
• Check claim status
• View and print remits
• Claim Data Reports
• AskUs confidential questions online
• Validate provider file demographics
• Validate/submit NPI numbers
• Submit your claims via XPressClaim
• Unlimited number of users allowed to register per
  account

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myTRICARE.com AskUs Feature

• No need to telephone PGBA ask questions online
• Receive a prompt reply in your personal, secure
  myTRICARE mailbox

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Thank You For Your Participation!
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Questions
UHC0048_061009