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UnitedHealthcare Provider Portal UHCprovider.com

Details: Information and resources for our online self-service tools on the UnitedHealthcare provider portal. On the portal you can get member eligibility, benefits, claims and referral information for multiple UnitedHealthcare plans, all in one location.

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› Url: https://www.uhcprovider.com/content/provider/en/resource-library/link-provider-self-service.html?CID=none Go Now

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Find a Care Provider UHCprovider.com

Details: Optum's Centers of Excellence networks are the gold standard in complex health care. Our original network, the Optum Transplant Centers of Excellence network, was developed in 1986 and has grown to be the largest network of its kind in the world, managing more than 14,000 transplant referrals in 2013.

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› Url: https://www.uhcprovider.com/en/find-a-provider-referral-directory.html Go Now

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UnitedHealthcare Community Plan of New York Homepage

Details: Health Insurance Portability and Accountability Act (HIPAA) Information. HIPAA standardized both medical and non-medical codes across the health care industry and under this federal regulation, local medical service codes must now be replaced with the appropriate Healthcare Common Procedure Coding System (HCPCS) and CPT-4 codes.

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› Url: https://www.uhcprovider.com/en/health-plans-by-state/new-york-health-plans/ny-comm-plan-home.html Go Now

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Claims, Billing and Payments UHCprovider.com

Details: For correct reimbursement of services, Critical Access Hospitals (CAH), Rural Health Clinics (RHC), Cancer Hospitals and Children’s Hospitals should send a copy of its most recent Interim Rate Letter (IRL) from CMS or their Medicare Administrative Contractor (MAC) by sending a fax to UnitedHealthcare Reimbursement Services at: Fax 866-943

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› Url: https://www.uhcprovider.com/en/claims-payments-billing.html Go Now

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Site Map UHCprovider.com

Details: Health Insurance Marketplace (Exchanges) - Chapter 4, 2021 Administrative Guides; Individual marketplace vs. small business health options program marketplace - 2021 Administrative Guide; UnitedHealthcare’s participation in Exchanges - 2021 Administrative Guide; What is the health insurance marketplace? - 2021 Administrative Guide

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› Url: https://www.uhcprovider.com/en/site-map.html Go Now

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Optum Pay™ UHCprovider.com

Details: Optum Pay basic and premium modified to better fit your needs. In response to feedback from health care professionals, Optum Pay has modified the benefits available in both the basic and premium portal access levels: For basic access, beginning May 22, 2021, it will include unlimited users for each account.

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› Url: https://www.uhcprovider.com/en/claims-payments-billing/electronic-payment-statements.html Go Now

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Coding, Submissions & Reimbursement UHCprovider.com

Details: UnitedHealthcare is updating testing guidelines, coding and reimbursement information for the COVID-19 health emergency, based on guidance from the Centers for Medicare & Medicaid Services (CMS), the Centers for Disease Control and Prevention (CDC), state and federal governments and other health agencies. Check back often for updates.

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› Url: https://www.uhcprovider.com/en/resource-library/news/Novel-Coronavirus-COVID-19/covid19-testing/covid19-testing-claim-coding-submissions.html Go Now

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Prior Authorization and Notification UHCprovider.com

Details: Please see the Administrative Guide for Commercial, Medicare Advantage and DSNP for complete information on health care professional and facility peer to peer requests.. Questions? For general questions about peer to peer reviews, please call UnitedHealthcare Provider Services, toll-free, at 877-842-3210, 7 a.m.–5 p.m. CT, Monday–Friday.To schedule or reschedule a peer to peer review

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› Url: https://www.uhcprovider.com/en/prior-auth-advance-notification.html Go Now

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Optum ID name changing to One Healthcare ID UHCprovider.com

Details: Optum ID name changing to One Healthcare ID. Last modified: April 12, 2021. On the evening of April 9, 2021, Optum ID was re-named One Healthcare ID as part of our digital initiatives, technology updates and migration of UnitedHealthcare services to a new cloud platform. What this change means for you.

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› Url: https://www.uhcprovider.com/en/resource-library/news/featured-news-2021/one-healthcare-id.html Go Now

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UnitedHealthcare Compass Plan Overview

Details: UnitedHealthcare Compass is an innovative commercial member benefit plan built on patient-centered health. Members choose a primary care provider (PCP) to help coordinate their care. Compass is offered as an Individual Exchange plan in New York. Created Date: 8/28/2020 4:52:52 PM

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› Url: https://www.uhcprovider.com/content/dam/provider/docs/public/health-plans/compass/NY-Compass-Overview.pdf Go Now

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UnitedHealthcare Community Plan of NY Specialist Referral form

Details: UnitedHealthcare Community Plan of New York specialist referral form continued • Patient must be a covered member at the time of service • Referrals must be generated for ni-network specialists only

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Prior Authorization Requirements for New York Medicaid

Details: Behavioral health services Many of our benefit plans only provide coverage for behavioral health services through a designated behavioral health network. For specific codes requiring prior authorization, please call the number on the member’s health plan ID card to refer for mental health and substance abuse/substance use services.

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› Url: https://www.uhcprovider.com/content/dam/provider/docs/public/commplan/ny/prior-authorization-and-notification/NY-UHCCP-Prior-Authorization-Effective-Jan-1-2020.pdf Go Now

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HIV Testing Requirements

Details: The New York State Department of Health \(NYSDOH\) requires care providers to offer routine HIV testing at least once to all patients, ages 13 or older, who are receiving primary care services at an outpatient clinic or from a physician, physician assista\ nt, nurse practitioner or midwife. Created Date: 4/7/2020 4:04:37 PM

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› Url: https://www.uhcprovider.com/content/dam/provider/docs/public/commplan/ny/bulletins-and-newsletters/NY-HIV-Testing-Requirements.pdf Go Now

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Cell-Free Fetal DNA Testing

Details: 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 documentation requirements outlined below are used to assess whether the member meets the clinical criteria for coverage but do not guarantee coverage of the service requested.

› Verified 9 days ago

› Url: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/cell-free-fetal-dna-testing.pdf Go Now

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Telehealth UHCprovider.com

Details: Depending on a member’s health plan, providers may need to adjust their administrative processes and systems when collecting member cost share (copays, coinsurance and deductibles). To determine if a member has a self-funded plan, please call UnitedHealthcare Provider Services at …

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› Url: https://www.uhcprovider.com/en/resource-library/news/Novel-Coronavirus-COVID-19/covid19-telehealth-services/covid19-telehealth-services-telehealth.html Go Now

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HouseCalls UHCprovider.com

Details: Innovative member engagement: 45- to 60-minute assessments include in-depth education of complex health conditions and identification of social determinants of health. Comprehensive APC network: 2,600+ licensed APCs, more than half of whom have three or more years of experience. HouseCalls services members in 47 states (not servicing MT, WY and

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› Url: https://www.uhcprovider.com/en/reports-quality-programs/Housecalls.html Go Now

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Update and Manage My Account UHCprovider.com

Details: Make changes to your name, address, notification preferences, sign-in information and verification options by logging in to your One Healthcare ID and choosing My Account from the menu at the top left of the screen. Add or change personal information such as department, title, business email address, postal address, phone and fax numbers.

› Verified 6 days ago

› Url: https://www.uhcprovider.com/en/my-account.html Go Now

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Injection and Infusion Services Policy, Professional

Details: For the purpose of this policy, the Same Individual Physician or Other Qualified Health Care Professional is the same individual rendering health care services reporting the same Federal Tax Identification number. Reimbursement Guidelines Injections (96372-96379) and Evaluation and Management Services by Place of Service

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› Url: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-reimbursement/COMM-Injection-and-Infusion-Services-Policy.pdf Go Now

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UnitedHealthcare Community Plan of Oklahoma Homepage

Details: Health Insurance Portability and Accountability Act (HIPAA) Information. HIPAA standardized both medical and non-medical codes across the health care industry and under this federal regulation, local medical service codes must now be replaced with the appropriate Healthcare Common Procedure Coding System (HCPCS) and CPT-4 codes.

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› Url: https://www.uhcprovider.com/en/health-plans-by-state/oklahoma-health-plans/ok-comm-plan-home.html Go Now

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Facet Joint Injections for Spinal Pain

Details: Listing of a code in this policy does not imply that the service descrbi ed 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.

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› Url: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/facet-joint-injections-spinal-pain.pdf Go Now

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UnitedHealthcare Community Plan of North Carolina Homepage

Details: Health Insurance Portability and Accountability Act (HIPAA) Information. HIPAA standardized both medical and non-medical codes across the health care industry and under this federal regulation, local medical service codes must now be replaced with the appropriate Healthcare Common Procedure Coding System (HCPCS) and CPT-4 codes.

› Verified 9 days ago

› Url: https://www.uhcprovider.com/content/provider/en/health-plans-by-state/north-carolina-health-plans/nc-comm-plan-home.html?cid=none Go Now

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National Drug Codes

Details: discount) directly to the Health Plan with HCPC units. Care Improvement Plus (CIP) 11 UHCprovider.com Call the customer service number on the member’s ID card. UnitedHealthcare of the River Valley 10 UHCprovider.com Call the NDC Provider team at 866-950-3513. UnitedHealthOne® (UnitedHealthOne, Golden Rule) 18 N/A 800-657-8205 Neighborhood Health

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› Url: https://www.uhcprovider.com/content/dam/provider/docs/public/claims/NDC-Claim-Submission-Inquiry-Guide.pdf Go Now

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UnitedHealthcare West Medical Management Guidelines

Details: The appearance of a health service (e.g., test, drug, device or procedure) in the Medical Management Guideline Update Bulletin does not imply that UnitedHealthcare provides coverage for the health service. In the event of an inconsistency or conflict between the information provided in the Medical Management Guideline Update Bulletin and the

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› Url: https://www.uhcprovider.com/en/policies-protocols/commercial-policies/sv-medical-mgmt-guidelines.html Go Now

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UnitedHealthcare Telehealth Visit Guide

Details: The health care industry is continually discovering new uses for telehealth. Each provider practice will need to decide how telehealth will fit into their clinical model and how it can be used to meet patient needs. Some common examples may include:* PCA-1-20-02221-Clinical-WEB_10202020 7

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› Url: https://www.uhcprovider.com/content/dam/provider/docs/public/resources/telehealth/Telehealth-Visit-Guide.pdf Go Now

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UHCprovider.com Home UHCprovider.com

Details: July 19, 2021 at 5:00 PM CT. COVID-19 national public health emergency extension. The U.S. Department of Health and Human Services has extended the COVID-19 national public health emergency by another 90 days. It was scheduled to end July 19, 2021 and now is …

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› Url: https://www.uhcprovider.com/?cid=em-providernews-PCA12101382-apr21 Go Now

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UnitedHealth Premium® Program UHCprovider.com

Details: Episodes include services delivered to a patient related to a specific procedure or treatment of a condition. Services may include those provided by other health care professionals as well as facility, pharmacy and ancillary services (e.g., diagnostic tests). Episodes are …

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› Url: https://www.uhcprovider.com/en/reports-quality-programs/premium-designation.html?rfid=UHCOContRD Go Now

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Skilled Care and Custodial Care Services – Community Plan

Details: • Non-health-related services, such as help with daily living activities. Examples include eating, dressing, bathing, transferring and ambulating. • Health-real ted services that can safely and effectiveyl be performed by trained non -medci al personnel and are provided for the primary purpose of meeting the personal needs of the patient or

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› Url: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/medicaid-comm-plan/skilled-care-custodial-care-services-cs.pdf Go Now

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UnitedHealthcare Oxford Clinical, Administrative and

Details: Effective Date: 08.01.2021 – This policy addresses reporting services of Advanced Practice Health Care Professionals, within a medical or other healthcare practice, to ensure submitted medical claims accurately identify the provider of service, including non-physician health care professionals.

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Neurophysiologic Testing and Monitoring

Details: Listing of a code in this policy does not imply that the service descrbi ed by the code is a covered or non -covered health service. Benefit coverage for health services is determine d by the member specific benefit plan document and applicable laws that may require coverage for a specific service.

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› Url: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/neurophysiologic-testing.pdf Go Now

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Telehealth UHCprovider.com

Details: Telehealth is medical care that’s delivered using technology platforms rather than in-person visits. It’s used to help with diagnosis, interventions and ongoing care management. At UnitedHealthcare, telehealth includes but is not limited to: Health care services delivered to individuals by care providers using interactive audio and visual

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› Url: https://www.uhcprovider.com/en/resource-library/telehealth.html Go Now

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Electronic Visits UHCprovider.com

Details: Depending on a member’s health plan, providers may need to adjust their administrative processes and systems when collecting member cost share (copays, coinsurance and deductibles). To determine if a member has a self-funded plan, please call UnitedHealthcare Provider Services at …

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› Url: https://www.uhcprovider.com/en/resource-library/news/Novel-Coronavirus-COVID-19/covid19-telehealth-services/covid19-telehealth-services-electronic-visits.html Go Now

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Policies and Clinical Guidelines UHCprovider.com

Details: We have compiled a list of evidence-based clinical guidelines and where they can be found for our quality and health management programs. We respect the expertise of the physicians and other health care professionals in our network and appreciate your help as we work together to offer our members better quality, better health outcomes and better cost.

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› Url: https://www.uhcprovider.com/en/health-plans-by-state/louisiana-health-plans/la-comm-plan-home/la-cp-policies.html Go Now

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Prolonged Services Policy

Details: rendering health care services reporting the same Federal Tax Identification number. Reimbursement Guidelines . Oxford reimburses Prolonged Services when reported with E/M codes in which time is a factor in determining level of service in

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› Url: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/oxford/prolonged-services-ohp.pdf Go Now

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Prior Authorization Requirements for UnitedHealthcare

Details: Behavioral health services . Many of our benefit plans only provide coverage for behavioral health services through a designated behavioral health network. For specific codes requiring prior authorization, please call the number on the member’s health plan ID card to refer for mental health and substance abuse/substance services.

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› Url: https://www.uhcprovider.com/content/dam/provider/docs/public/prior-auth/pa-requirements/commercial/UHC-Commercial-Advance-Notification-Prior-Authorization-Requirements-6-1-2021.pdf Go Now

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Information for UHCWest.com Users UHCprovider.com

Details: UHCWest.com is retiring on January 29, 2018. You’ll need an Optum ID to use Link self-service tools. Your Link dashboard has your capitation, eligibility and patient management reports and online transactions such as verifying eligibility, checking the status of a claim and submitting or checking the status of prior authorization.

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› Url: https://www.uhcprovider.com/en/resource-library/news/news-for-uhcw-users.html Go Now

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TrackIt UHCprovider.com

Details: If you need technical help, please email or call our UnitedHealthcare Web Support at 866-842-3278, option 1. Representatives are available Monday - Friday 7 a.m. - …

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› Url: https://www.uhcprovider.com/en/resource-library/link-provider-self-service/trackIt.html Go Now

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Rhinoplasty and Other Nasal Surgeries

Details: 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 documentation requirements outlined below are used to assess whether the member meets the clinical criteria for coverage but do not guarantee coverage of the service requested.

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› Url: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/rhinoplasty-other-nasal-surgeries.pdf Go Now

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Lower Extremity Invasive Diagnostic and Endovascular

Details: 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 documentation requirements outnli ed below are used to assess whether the member meets the clinci al criteria for coverage but d o not guarantee coverage of the service requested.

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› Url: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/lower-extremity-vascular-angiography.pdf Go Now

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UnitedHealthcare Demographic Change Request Form

Details: care service facility or because they provide health care services. This location, facility or any of its care providers, employees, volunteers or patients is or was the target of threats or acts of violence within the past year. The care provider is currently enrolled in the state’s Safe at Home program.

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› Url: https://www.uhcprovider.com/content/dam/provider/docs/public/resources/link/Demographic-Change-Request-Form.pdf Go Now

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New Patient Visit Policy, Professional

Details: This reimbursement policy applies to services reported using the 1500 Health Insurance Claim Form (a/k/a CMS-1500) or its electronic equivalent or its successor form. This policy applies to all products and all network and non-network physicians and other qualified health care professionals, including, but not limited to, non-network authorized and

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› Url: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/medicaid-comm-plan-reimbursement/UHCCP-New-Patient-Visit-Policy-(R0004).pdf Go Now

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Advance notification/prior authorization list

Details: The list of services that require advance notification and prior authorization is the same. The process for providing notification and submitting a prior authorization request is the same. Services that require prior authorization require a clinical coverage review based on medical necessity.

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› Url: https://www.uhcprovider.com/en/admin-guides/administrative-guides-manuals-2021/ch7-medical-management-2021/adv-not-prior-auth-list-ch7-guide.html Go Now

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Medical & Drug Policies and Coverage Determination

Details: Benefit coverage for health services is determined by the member specific benefit plan document, such as a Certificate of Coverage, Schedule of Benefits, or Summary Plan Description, and applicable laws that may require coverage for a specific service. The member specific benefit plan document identifies which services are covered, which are

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› Url: https://www.uhcprovider.com/en/policies-protocols/comm-plan-medicaid-policies/medicaid-community-state-policies.html Go Now

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UnitedHealthcare Community Plan of Hawaii Homepage

Details: Health Insurance Portability and Accountability Act (HIPAA) Information. HIPAA standardized both medical and non-medical codes across the health care industry and under this federal regulation, local medical service codes must now be replaced with the appropriate Healthcare Common Procedure Coding System (HCPCS) and CPT-4 codes.

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› Url: https://www.uhcprovider.com/en/health-plans-by-state/hawaii-health-plans/hi-comm-plan-home.html Go Now

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Supply Policy, Professional

Details: to health care services provided in a particular case. Further, the policy does not address all issues related to reimbursement for health care services provided to UnitedHealthcare Medicare Advantage enrollees. Other factors affecting reimbursement may supplement, modify or, in …

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› Url: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/medadv-reimbursement/MEDADV-Supply-Policy.pdf Go Now

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07/2020: Oxfordhealth.com Provider Portal Login Change

Details: Effective Oct. 1, 2020, OxfordHealth.com will transition from using existing Oxford credentials to an Optum ID at login. If you haven’t already done so, you will need to create an Optum ID in order to access the portal. Please see here for directions to create your …

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› Url: https://www.uhcprovider.com/en/resource-library/news/2020-network-bulletin-featured-articles/0720-oxfordhealth-portal-change.html Go Now

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New Jersey Commercial Health Plans UHCprovider.com

Details: A health savings account (HSA) may be available to pay for qualifying medical expenses, including the annual deductible. The UnitedHealthcare Motion™ program provides a financial reward (in the form of a reimbursement for out-of pocket medical expenses or an HSA deposit) for meeting daily activity goals.

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› Url: https://www.uhcprovider.com/en/health-plans-by-state/new-jersey-health-plans/nj-commercial-plans.html Go Now

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Electronic Payment Solutions UHCprovider.com

Details: OptumHealth Financial Services, a UnitedHealthcare-affiliated company, provides payment services to the health care industry and offers various claim payment options. UnitedHealthcare-affiliated companies may receive transaction fees or other compensation related to some payment options. The virtual card payment program will exclude KanCare

› Verified 8 days ago

› Url: https://www.uhcprovider.com/en/claims-payments-billing/Electronic-Payment-Solutions.html Go Now

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Illinois AARP® Medicare Advantage Plans UHCprovider.com

Details: Health Maintenance Organization (HMO) plans have a defined network of contracted local physicians and hospitals to provide member care. Generally, members must use these care providers to receive benefits for covered services, except in emergencies.

› Verified 8 days ago

› Url: https://www.uhcprovider.com/en/health-plans-by-state/illinois-health-plans/il-medicare-plans/il-aarp-medicarecomplete-plans.html Go Now

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