UHCprovider.com > Menu click in the upper-left corner, then select Use vendor recommendations or services to access authorization information, go to UHCprovider.com and then sign in to the vendor portal or go to UHCprovider.com/eligibility Sign in to the vendor portal on UHCprovider.com or go to UHCprovider.com/claims for more information. Two plans have been finalized with the State of Ohio to serve Portage, Stark, Summit and Wayne counties: CareSource and UnitedHealthcare Community Plan of Ohio. For providers seeking contracts with managed care plans, below you will find contact information for employees in their respective contract departments. As a provider, you must make it clear that you are looking for a contract for the network of domestic and community providers. There are also some additional useful contact information listed. Changes to operating policies and other electronic tools are available on our website under UHCprovider.com. UHCprovider.com/OHcommunityplan > newsletters and newsletters If there is a conflict between your agreement and this Caregiver`s Guide, use this guide unless your agreement states that you should use it instead. In the event of any conflict between your agreement, this manual and applicable federal and state laws and/or state contracts, applicable federal and state laws and regulations, and/or state contracts will prevail. Information is also available on UHCprovider.com/edi. Notify us of any suspected fraud or abuse by a service provider or member. Log in to UHCprovider.com/claims to access the Provider Portal, then select the UnitedHealthcare online app Welcome to the UnitedHealthcare Community Plan Provider Guide. This up-to-date reference manual allows you.
B, it is up to you and your employees to find important information, such as processing a claim and submitting requests for prior approval. This guide also includes important phone numbers and websites on the How to Contact Us page. Service providers must participate in the VFC program, which is administered by the Department of Health and Seniors Services (DHSS), and must use the free vaccine when administering the vaccine to eligible eligible children. Providers must register as VFC suppliers with DHSS to invoice vaccine administration. 6. Can my parent/spouse or someone else speak to the managed plan on my behalf? Call 24/7 for help with referrals, pre-approvals, admissions, layoffs, and coordinating member care. Refer high-risk members (i.B asthma, diabetes, obesity) and members who require private nursing care. UM helps prevent overuse and underuse of medical services by making clinical coverage decisions based on available evidence-based guidelines.
Seek approval or notification of the procedures and services described in the Pre-Approval and Notification Requirements section of this guide. Doctor, healthcare professionals, facilities, and additional care Ohio: eligibility, claims, benefits, authorizations, and appointments related to Medicaid and UnitedHealthcare. . Fax requests for medically necessary durable medical devices. If we ask Medicare and Medicaid to terminate your membership in our plan, we must provide you with our reasons in writing. We must also explain how you can file a complaint about our request to terminate your membership. For more information on filing a complaint, please see the Objections and Complaints section of this website. We offer members over the age of 21 up to six visits per calendar year with a networked chiropractor. This service does not require prior approval. Request a copy of our Unified Messaging policies or program information.
Refer high-risk OB members. Fax the form for the first prenatal visit. . Nationwide, MyCare Ohio will be available in seven regions covering 29 counties and approximately 114,000 people. We are located in the Central East region of the MyCare Ohio demonstration project, which includes Portage, Stark, Summit and Wayne counties. MyCare Ohio is a three-year demonstration project administered by the Ohio Department of Medicaid and designed for people receiving both Medicare and Medicaid benefits under a program managed by a managed care plan. These include people with disabilities, seniors, and people who receive behavioral health services. Check the status of a claim or get information about the completion or correct filing of claims. Call Monday to Friday from 8 a.m. .m to .m .m to 5 p.m. .m.m Centre Time. Claim issues include overpayment, underpayment, refusal to pay, or an original or corrected determination of damages with which you disagree.
Technical Assistance Service (pharmacy call): 877-305-8952. OptumRx monitors and manages our networked pharmacies. Prior approval is required for all eye exams and routine equipment. Permits must be obtained from March Vision. If you have any questions about this guide or our policies, please call Provider Services. See How to contact us at the bottom of the page. . 8 a.m.m. – 8 p.m. Central Time, Monday to Friday. Voicemail available 24 hours a day, seven days a week.
Contact us if you have any problems with your ID. Available from 7:.m a.m. to 9 p.m.m. Central Time, Monday to Friday; 6 a.m – 18.m. Central Time, Saturday; and 9 a.m. – 6 p.m.m. Central time, Sunday. .
Call Member Services to plan transportation or get transportation assistance through MTM. To arrange non-emergency transportation, please call three days in advance and refer members to behavioral health services. A PCP transfer is not necessary. Confirm the benefits and/or prior approval of a member. Self-service functionality for updating or verifying credentials. The Enterprise Voice portal provides self-service features or call admission control before speaking to a contact center agent. Use the UnitedHealthcare Provider Portal to access the MyScript PreCheck tool. Ask for pre-approval and get the results and see which recipes require prior approval or are not covered or preferred to check coverage and price, including more cost-effective alternatives. . MarQuita Epps marquita.epps@uhc.com p 330.928.7732 f 855.839.0992 Elissa Douglas elissa.douglass@uhc.com p 612.642.7796 c 614.499.5131 f 855.428.2432 Access information about your country-specific community plan on this website. The requirements can be found in the Overpayment section before submitting your application. .
5. How often do I receive a new Medicaid Managed Care Plan card? Confirm membership eligibility online or call our toll-free Interactive Voice Response (IVR) system 24/7. Submit new recommendation requests and check the status of recommendation submissions. The process of completing the notification/pre-approval request and the deadline remain the same. Learn how to use the Advance Notification of Authorization (EAAP) tool, complete the notification/pre-approval process, or confirm a coverage decision. 7 a.m. – 19 p.m. Central time, Monday to Friday.
Provider Pharmacy Prior Authorization Help Desk: 800-310-6826 Provider Relations Department hpsupport@caresource.com newcontract@caresource.com 800.488.0134 UnitedHealthcare Community Plan reserves the right to supplement this manual to ensure that its terms comply with applicable federal and state laws and regulations. LabCorp and Quest Diagnostics are network labs. .