Better Care, Better Value (KM1007763/KM1866001)
Full VBC and Split VBC
What are the two types of VBC arrangements
Employers may choose to pay the entire premium or part of the premium
What is subsidized
Team who supports a member through their denture journey
What is the Specialized Denture Support Team
Phone calls, texts, and letters
What are member outreaches
Provides contact information regarding dedicated teams for this specific high-touch employer groups
What is High Profile Employer Groups - Index (KM1004166)
A set payment amount Per Member Per Month with financial risk falling on the providers
What is capitation
These retired employer groups are serviced by a dedicated team
What are High Profile Employer Groups
Dental services such as exams, cleaning, and x-rays
What is routine dental coverage
Housecalls visits are especially effective from members who struggle with this
What is going to the doctor's office
Provides guidelines for help in handling difficult caller situations
What is Situational Guidelines - Index (KM1004126)
Claims processing and utilization/medical management (authorizations)
What are the two primary functions assigned to VBC Medical Groups by UHC
800 series, endorsed, National PPO, subsidized, and connector models plans
What are Employer Group Types
AEP or within the first 3 months of new plan effective date
What is a dental rider enrollment timeframe
Group member does not want a stranger in their home. Provide options and team contact number.
Warm transfer to Optum Housecalls Scheduling Coordinator 866-276-9191
This OneSource provides guidance to request replacement materials, request reprints, initiate Do Not Call/Do Not Mail, or complete SharePoint escalations
What is Member Materials OneSource (KM1974070)
Tool used: Locate Group #91038
Name the delegated entity and are claims; prior auths; referrals delegated
PST tool:
What is Optum Health Networks; yes
Provide tool used: Locate IBM employee with NPPO/Essentials Plan
Member needs to see a podiatrist and wants to know the INN and OON copays
What is GRIF
$50 both INN and OON
Use the Maestro & Uhcdental.com (website) to identify:
Member ID# 988360095
CPT Code description D1206
Covered or not covered benefit
Provide any frequency limitation
What is a flouride treatment
covered
2 per 1 plan year
Show site used to check Housecalls Eligibility: Member ID# 931380123
Provide Housecall current status
Optum Housecalls Member Look-Up Tool Website KM1191502
Member refused
Provides guidance to help us and CMS measure our members' experiences and satisfaction with their health plan.
Annual CAHPS and HOS Surveys Index (KM1004845)
Use PST tool: Locate Group #90875; year 2026.
Delegated entity, claims address and electronic payer ID
What is:
Optum Health Network
P.O. Box 30539, Salt Lake City, UT 84130
LIFE1
Name the tool used: Locate
BNA Salaried employer group's name and dedicated sales phone number
What is the AKA list:
Boeing 877-714-0178
Using Maestro: Identify
Member ID# 913583650
Vision vendor and allowance amount for frames or contact lenses
What is UHC Vision and $300
Provide walk-thru of scheduling a Housecalls Visit:
Name tool used
Member ID# 91197231
PCSS tool
Provides guidance on individual eligibility for Medicare in the following situations:
Age (65 years or older)
Disability
End-stage renal disease (ESRD) and ALS
What is General Medicare Eligibility KM1732103