Providers
What is the tool called where providers can submit Prior Authorizations?
PAAN - Prior Authorizations & Notifications via UHC Provider Portal
When click noting benefits, what should you save as your subject/category
Category: Medical Benefits
Provider calls with the member in office, wanting to update/change their PCP. Which SOP would help you with this call?
Provider Lookup PCP Change SOP
What does APRIL stand for?
A Path to Research, Information, & Link
True or False: If the member is not eligible in facets, we still quote the provider benefits they they called in for.
False
If an OON provider is requesting PA, who should you refer the provider to?
the Members PCP
I could check this section to see if a referral is required for the members plan
Specialist Benefit
Provider is calling to disputing members eligibility effective dates in our system for a NJ member. Which SOP should you use to assist the provider?
Provider Eligibility Status SOP
Provider is asking if CPT 93308 requires Prior Authorization for a NY CAID member. Which system do I go to first?
EPAL
DMEVS
Providers (including labs, and medical supply stores) bill claims on which type of claim form?
CMS 1500
Services like physical, speech, and occupational therapy could be found under what benefit in the Benefit Summary?
Rehabilitation Services
Im having trouble remembering how to HIPPA verify the member. Where could I find our HIPPA resources, including the HIPPA Confidentiality Resource Tool?
Advocate Call Handling OneSource
Provider is requesting the BIN/PCN number for NY Medicaid. Which job aid would assist me?
CS Pharmacy CAG Job Aid
Where can I go to find members coordination of benefits information?
COB tab
A provider calls stating their address in our system needs to be updated. What options does the provider have to make those changes?
Providers can email hpdemo@uhc.com or updated their demographics at uhcprovider.com/portal
Services such as prosthetic devices and orthopedic shoes can be found where in the Benefit Summary?
DME benefit
If the provider ask if a cpt/hcpcs code is valid or billable, how can I look up the code?
Change Knowledge Base to: Codes C&S and hit Apply to Search
This tool would give me more information on DSNP plans in the states that I service
DSNP Toolkit
I show a member is not eligible in facets, with no cob listed. What is the next step I should take?
Do a last name/DOB search to see if we are managing any other policy for the member and then check applicable state system.
A member’s PCP calls, looking for an INN specialist to refer the member to. Name two ways you can locate that information
Channeling via Facets or Find a Dr. at uhcprovider.com
Provider would like to know what address they can mail the claim to. Where can you find that in the Benefit Summary?
Claims Address and Payor ID
Provider is calling about a possible duplicate claim. Which SOP would assist you with this call?
Incorrectly Keyed or Duplicate Claim SOP
Provider calls stating they would like to be credentialed with UHC and join our network. What tool would assist this call?
Provider Call NWM, Credentialing, and Demographics Onesource