Provider Relations
September 2014
Agenda
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Physician Advocates & Network Management
Reconsideration versus Appeal
Notifications/Prior Authorizations
Optum Cloud
ICD-10
Updates
Contact Information
Questions
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Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Advocates &
Network Management
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What is a Physician Advocate?
 A UnitedHealthcare navigational
specialist

United
Healthcare
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
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Physician
Advocate
Office Staff
Physicians
Responsive, Proactive, Reliable and
Simplistic!
Network Account Management
Your Partner for Contract Needs
Contract negotiations and management
 Contract interpretation questions
 Fee schedule inquiries
 Product offerings and amendments
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Reconsiderations versus Formal
Appeals
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Reconsideration vs. Appeal
Step 1: Claim Reconsideration
Step 2: Claim Appeal
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Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Prior Authorization/Notifications
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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
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Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Optum Cloud Resources
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Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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.
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*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.
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Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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.
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Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Optum Cloud Dashboard
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
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Proprietary
Proprietary Information
Information of
of UnitedHealth
UnitedHealth Group.
Group. Do
Do not
not distribute
distribute or
or reproduce
reproduce without
without express
express permission
permission of
of UnitedHealth
UnitedHealth Group.
Group.
ICD-10
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Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
UnitedHealthcare’s ICD-10 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
Website
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
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UHC2231l_20130611
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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
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UHC2231l_20130611
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Updates
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Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
September Network Bulletin
• 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
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Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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
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Questions?
Thank you for attending!
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