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Oxford Health Plans

Details: Browse our Provider/Facility Resources Members Stay informed about coronavirus (COVID-19) Providers Stay informed about coronavirus (COVID-19)

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Search For Doctor

Details: Today's Date: Sun Apr 18 2021 ©1996-2020, Oxford Health Plans, LLC

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Providers > Search for a Doctor

Details: • Health Guide A-Z • Asthma • Cancer • Depression • Diabetes • Heart Disease: Living Better • Healthy Women • Healthy Men • Healthy Seniors • Diet & Nutrition • Pregnancy & Parenting • Vitamins & Supplements: Doctor Search • Doctors • Specialists • Hospitals • Health Facilities • Complementary and Alternative Care

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Home > Contact Us > Oxford Phone Numbers

Details: Behavioral Health Line: 1-800-201-6991 (8 AM - 6 PM, Mon - Fri) Behavioral health coordinators provide information such as referrals to behavioral health providers or precertification for mental health or substance abuse services.

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Precertification and Referrals

Details: Home Health Care* Home care includes, but is not limited to, physical therapy, nursing visits and occupational therapy. Office-based Procedures • Any surgical procedure, major diagnostic test and endoscopic procedure • Treatment of TMD • Therapeutic termination of …

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Oxford's Laboratory Program

Details: Also effective January 1, 2007, Quest Diagnostics will no longer participate in the Oxford Health Plans network. This decision means that, for your Oxford patients laboratory services provided by Quest Diagnostics after December 31, 2006, will be out-of-network and, as such, will result in increased health …

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Oxford Medical Medical Claim Form

Details: Health Plans (CT), Inc. Administrative services provided by Oxford Health Plans LLC. Home Address: Home Address: Provider Address: Name (Last, First, MI): Address Where Services Were Rendered: Member ID (from Health Plan ID card, can be up to 11 digits): Group Number (can be 6 or 7 digits): Phone #: ( ) Date of Birth: New Address?: Yes No City

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UnitedHealthcar€ Oxford

Details: health insurance claim form approved by national uniform claim committee (nucc) 02/12 group health plan 3. p tients birth te feca other la insured's i.d. number pica (for program in item 1) pica 1. medicare medicaid tricare ) champva state sex 2. patient's name (last name, first name, middle initial) 5. patients address (no., street) 4.

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Claims, Billing and Provider Reimbursement

Details: health exceptions • Participates in a delegated arrangement with an Oxford contracted vendor and either (a) the vendor has not adopted this policy, or (b) Oxford has determined that the claims submitted directly to the vendor should be excluded from this policy; in either case, only the claims submitted to Oxford are included in this policy

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Spine Surgery Information Request Form

Details: may contain protected health information (PHI) and must be handled according to applicable state and federal laws, including, but not limited to Health Insurance Portability and Accountability Act (HIPAA). Individuals who misuse such information may be subject to both civil and criminal penalties. If you

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Drug Coverage Guidelines

Details: the service described by the code is a covered or non-covered health service. Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws that may require coverage for a specific service. The inclusion of a code does not imply any right to reimbursement or guarantee claim payment.

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Home > Contact Us

Details: Oxford Health Plans, Inc. 48 Monroe Turnpike Trumbull, CT 06611: Important Phone Numbers: full list of phone numbers : Benefits Administrators and Brokers: Please call 888-201-4216 to speak with a Group Service Associate, Monday through Friday, 8AM - 5PM. To speak with a Sales Representative in your area, press option 5 and select the

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Fetal Aneuploidy Testing Using Cell

Details: Essential Health Benefits for Individual and Small Group For plan years beginning on or after January 1, 2014, the Affordable Care Act of 2010 (ACA) requires fully insured non-grandfathered individual and small group plans (inside and outside of Exchanges) to provide coverage for ten categories of Essential Health Benefits (“EHBs”).

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Basic Insurance Terminology

Details: Health Benefit Plan: The insurance product, offered by a health insurance company or HMO, defined by the contract and represents a set of covered services and a provider network. Health Maintenance Organization (HMO): A type of health benefit plan under which the members receive all medical services through a specific group of participating

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Oxford New York Small Group (1-100

Details: Owners and spouses may enroll in a group health plan only if the business has an eligible common law employee enrolled in the Oxford plan. (See Section II.B.3 above.) B. Eligible Former Employees who may enroll: Former employees eligible for COBRA or state continuation may …

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Addition/Termination Change Form

Details: Addition/Termination Change Form 1 0 #PY )PU 4QSJOHT "3 2 A. Employer/Employee Information (To be completed by the employer)

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6055 Aggregate Group Reporting Requirements

Details: Oxford HMO products are underwritten by Oxford Health Plans (NJ), Inc. and Oxford Health Plans (CT), Inc. Oxford insurance products are underwritten by Oxford Health Insurance, Inc. Administrative services provided by Oxford Health Plans LLC. MS-17-419 MT1147094 …

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Oxford Sweat Equity Program Reimbursement Form

Details: Oxford HMO products are underwritten by Oxford Health Plans (CT), Inc. and Oxford Health Plans (NJ), Inc. Oxford insurance products are underwritten by Oxford Health Insurance, Inc. MS-16-347 9/16 ©2016 Oxford Health Plans LLC.

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Complaints and grievances

Details: Or what if my health will be harmed by waiting 7 days? You or your doctor can file request an expedited appeal (sometimes called a “fast appeal”) either in writing, or over the phone by calling 1-800-234-1228 TTY users should call 1-800-201-4874, Monday through Friday, 8 am to 6 pm. Please call 1-800-303-6719 for assistance in Chinese, 1

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Participating Provider Request for

Details: underwritten by Oxford Health Insurance, Inc. Submitting this Claim(s) Review Request Form 1.Complete one form per claim or multiple claims involving the same issue.

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Home > Contact Us > Mailing Addresses

Details: Oxford Health Plans PO Box 29135 Hot Springs, AR 71903: Oxford Claims Department PO Box 29130 Hot Springs, AR 71903: Oxford Health Plans Dental Administrative Offices P.O. Box 609 Colorado Springs, CO 80949-9549

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Medicare Advantage Plans

Details: Oxford Medicare Advantage is a Medicare Advantage plan being offered by Oxford Health Plans. Many Medicare beneficiaries are relying on Medicare Advantage plans for their primary healthcare coverage. The reason is that many healthcare companies have been able to provide members with 100% of their traditional Medicare benefits, plus many other

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FAX and Address Reference Guide for

Details: Oxford Health Plans LLC. P.O. Box 7082. Bridgeport, CT 06601-7082 Per Oxford’s policy, all claims should be submitted electronically to Oxford using our Payer ID (06111) and include the rendering Provider’s Oxford Provider ID and Tax ID.

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Pharmacy Locations for Oxford Members

Details: To determine if your health plan includes coverage for a specific provider and services, it is recommended that you log into myuhc.com using your member ID card information, check with the provider's office prior to your appointment or call the toll-free phone number on your health plan ID card.

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Oxford Provider Reference Manual Commercial Plans

Details: health care professionals, facilities and ancillary providers; unless otherwise specified in the specific item, all items are applicable to all types of providers subject to this Guide. “Us,” “we” or “our” refers to Oxford or those Products and services subject to this Manual. Oxford Medicare Advantage Exceptions to UnitedHealthcare

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Connecticut Small Groups

Details: Connecticut Small Group (1-50): Oxford Health Plans (CT), Inc. (OHP) Applies to Oxford Non-Gated HMO, Oxford Non-Gated HMO HSA, Oxford HMO HSA, Primary Advantage . Connecticut Small Group Application - OHP

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Physician and provider demographic

Details: Mid Atlantic Health Plan 1-855-265-8686 MD, VA, WV, DC, DE, Harvard Pilgrim Health Care Medica 1-855-264-7582 Neighborhood Health Partnership 1-855-263-9590 UnitedHealthcare Plan of the River Valley, Inc. 1-855-263-9590 UnitedHealthcare WEST (Formerly known as PacifiCare Health …

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New York Member Enrollment Form – OHI

Details: New . York Member Enrollment Form – OHI. MAILING ADDRESS: P. O. Box 29142, Hot Springs, AR 71903 • 1-800-444-6222. OHINY MEF LS 1109 2019 [4318 REV 12]

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About Oxford Medicare Advantage

Details: Oxford Medicare Advantage was founded in 1992 in order to provide Medicare recipients with an alternative to traditional Medicare. Over 60,000 Medicare beneficiaries in the tri-state area are currently accessing benefits and services beyond those offered by traditional Medicare through one of our Oxford Medicare Advantage plans.

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Abortions (Therapeutic and Elective)

Details: Essential Health Benefits for Individual and Small Group For plan years beginning on or after January 1, 2014, the Affordable Care Act of 2010 (ACA) requires fully insured non-grandfathered individual and small group plans (inside and outside of Exchanges) to provide coverage for ten categories of Essential Health Benefits (“EHBs”).

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Preventive Care Services

Details: Essential Health Benefits for Individual and Small Group For plan years beginning on or after January 1, 2014, the Affordable Care Act of 2010 (ACA) requires fully insured non-grandfathered individual and small group plans (inside and outside of Exchanges) to provide coverage for ten categories of Essential Health Benefits (“EHBs”).

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Payment Appeals and Grievances

Details: Oxford Health Plans P. O. Box 7081 Bridgeport,CT 06601-7081 To be processed, an appeal* must include the reasons you believe that the claim should not have been denied (or the reasons additional reimbursement should be made), the Member’s name and Oxford ID number and a copy of the remittance advice for

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Product Portfolio

Details: Oxford offers individual health insurance plans in New York and New Jersey. To be eligible for an individual plan, the applicant must be a state resident who is ineligible for group coverage (i.e., self-employed). For more information, please call Oxford at 800-216-0778, or write to: Oxford Health Plans, Attn. Personal Plan Kit Request, 44

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Filing Deadlines for Claims Submissions

Details: Provider: A Physician, Health Care Professional, or Facility licensed, registered, certified, or accredited as required by state law. Policies Member Administrative Grievance & Appeal (Non Utilization Management) Process & Timeframes Practitioner/Provider …

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Practitioner/Provider Administrative

Details: ©1996-2016, Oxford Health Plans, LLC PROCEDURES AND RESPONSIBILITIES Pre-Appeal Claim Review Before requesting an appeal, if practitioners or providers need further clarification of a payment determination, they may contact the health plan, verbally or in writing, for a review of the claims payment issue. The health plan will

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Hearing Aids and Devices Including

Details: Essential Health Benefits for Individual and Small Group For plan years beginning on or after January 1, 2014, the Affordable Care Act of 2010 (ACA) requires fully insured non-grandfathered individual and small group plans (inside and outside of Exchanges) to provide coverage for ten categories of Essential Health Benefits (“EHBs”).

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Extended Benefits for Total

Details: Health Benefits": Where an employee's group coverage terminates because the employee's active employment or membership in an eligible class ends due to total disability, the employee will be entitled to elect to continue his or her group health coverage subject to the following:

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Home > Contact Us > Oxford Phone Numbers

Details: Behavioral Health Line 1-800-201-6991 (8 AM - 6 PM, Mon - Fri) Behavioral health coordinators provide information such as referrals to behavioral health providers or precertification for mental health or substance abuse services.

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Emergency Room Visits (Including

Details: Essential Health Benefits for Individual and Small Group For plan years beginning on or after January 1, 2014, the Affordable Care Act of 2010 (ACA) requires fully insured non-grandfathered individual and small group plans (inside and outside of Exchanges) to provide coverage for ten categories of Essential Health Benefits (“EHBs”).

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Prescription Reimbursement Request Form

Details: Parent is not enrolled in the same Group Health plan as the child 2. Parent does not reside in the same household as the subscriber under the child’s Group Health plan: If your child is covered under two or more health plans, state law determines the order of benefits for processing claims.

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HIPAA Adjustment and Remark Code

Details: Oxford Health Plans, PO Box 7027, Bridgeport, CT 06601-7027. A 11 T406 This service has been denied because there is a mismatch between the diagnosis and the procedure. Please submit this explanation of benefits with any medical records, which support the medical necessity of this service to Oxford Health Plans for reconsideration.

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MEDICAL AND ADMINISTRATIVE POLICY INDEX

Details: Oxford Health Plans > Practical Resources > Medical & Administrative Policy Index: Medical & Administrative Policy Index: A complete library of our clinical, administrative and reimbursement policies is available below for your reference. The appearance of an item or procedure on the list indicates only that we have adopted a policy; it does

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New Jersey Small Groups

Details: New Jersey Small Group (2-50): Oxford Health Plans (NJ), Inc. (OHP) Applies to Primary Advantage. Small Group Application - OHP New Jersey Small Member Enrollment/Change Request Form - OHP New Jersey Small Employer Health Benefits Waiver of Coverage New Jersey Small Employer Health Benefits Waiver of Coverage (Spanish)

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Completing and submitting this form

Details: way. Call us at the toll-free phone number on your health plan ID card and we will work with you and, if necessary, your doctor to find another way for you to earn the same reward. • Any information we collect in conjunction with this program is kept confidential according to HIPAA requirements and is separate

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