OptumCare Quick Reference Guide Arizona

Quick Reference Guide: Arizona

Welcome to OptumCare Network in Arizona

OptumCare Network in Arizona is an Independent Physician's Association with a local management team. We offer a full range of services to assist physicians and other providers in their managed care and business operations.

This Quick Reference Guide provides a quick look at the most important information you'll need when working with OptumCare patients.

Eligibility

OptumCare currently has exclusive contracts with the participating plans listed below for patients in Maricopa county.

Patients can take advantage of what OptumCare Network in Arizona has to offer if: they select a primary care physician from the OptumCare Network, and they have coverage through one of the listed participating Medicare Advantage Plans.

Participating Plans

Corrected claims can be submitted electronically by following the guidelines below:

Professional Claims 1. On the CMS-1500 form, enter frequency code "7" in the Medicaid Resubmission field (box 22). The provider can enter the claim number in the Original Ref No. field, which is also in box 22. 2. In the Additional Claim Information field (box 19), add a note indicating the reason for the resubmission (i.e. changed CPT code, added a modifier, corrected EOB was received, etc.).

Facility Claims 1. On the CMS-1450 form, in the Type of Bill field (box 4), enter frequency code "7."This will indicate the claim is a corrected claim.

Electronic Fund Transfer (EFT)

Optum offers EFT through ePayment. This can drastically reduce expense, shorten the reimbursement cycle and streamline workflow.

We work with Emdeon to provide payer remittance data electronically. You may call Emdeon at 1-866-506-2830 and select option 1 or sign up online by visiting eft.

AARP? MedicareComplete? insured through UnitedHealthcare? Plan Name: AARP? MedicareComplete? Plan 1 CMS Contract: H0609-026 AARP? MedicareComplete? insured through UnitedHealthcare? Plan Name: AARP? MedicareComplete? Plan 2 CMS Contract: H0609-027

UnitedHealthcare? Group Medicare Advantage Plan Name: UnitedHealthcare? Group Medicare Advantage (HMO) CMS Contract: H0303-801, H0303-804, H0303-805

Referrals

Refer to arizona/providers for a complete provider directory with eligible specialists. The primary care physician is responsible for coordinating all referrals. No written referral is required for in-network providers.

Submitting a Claim

Follow these guidelines when submitting a claim through OptumCare.

For electronic submissions, use payer ID: LIFE1

For paper submissions, use OptumCare Claims PO Box 46770 Las Vegas, NV 89114

Contact Information

Below are numbers and websites you can use to contact OptumCare or find information on related services.

OptumCare Website: Use our website to log into the OptumCare Provider Portal - a tool giving you access to eligibility, prior authorization and claims information in real time. You'll also find our referral lookup tool, important forms, and many other resources online. Register for your account access at secure.optummedicalnetwork. com/provider/account/register

OptumCare Service Center: Phone: 1-877-370-2845. Advocates are available to answer questions Monday - Saturday, 8 a.m. - 8 p.m.

OptumCare Community Center: Phone: 1-623-707-0800. For more information on classes and events at the OptumCare Community Center, visit our patient website: Online: arizona/patients/community-center/

Laboratory: The exclusive participating laboratory for OptumCare patients is the Laboratory Corporation of America (LabCorp). Phone: 1-800-788-9743 Online:

Mental Health: Optum Behavioral Health Phone: 1-800-579-5222

Durable Medical Equipment and Infusion Services: Preferred Homecare Phone: 1-480-446-9010

Physical, Occupational, Speech Language Therapy, and covered Chiropractic Services: Optum? Physical Health Phone: 1-800-873-4575

PROVIDER USE ONLY

continued on back

Home Health Care (includes Nursing, PT/ OT/ ST, Social Work, Aide): Professional Healthcare Network (PHCN) Phone: 1-602-395-5100

Note: Referral forms for Home Health Services can be found on the Optum Medical Network website: > providers > provider resources

Prior Authorizations

Prior authorization is required for certain services based on the patient's benefit plan.

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Listed below are numbers you may need to call to request prior authorization:

Urgent & Routine: Phone: 1-877-370-2845

Rx Prior Authorization: For UnitedHealthcare Patients: Phone: 1-800-711-4555 | Fax: 1-800-527-0531 Online: > health care professional > prior authorizations

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Transplant Prior Authorization: Phone: 1-888-936-7246

PO Box 29830 Hot Springs, AR 71903-9830

contract. Enrollment in plan's contract renewal

the plan with

Preferred Specialty Groups

To help provide our patients with the highest level of service, OptumCare has established preferred or exclusive arrangements with certain specialty groups. Preferred and exclusive specialists were chosen based on quality, performance metrics, geographic location and availability of clinical services. Please direct all patient referrals within these specialties to the groups listed below.

Nephrology Referrals: Arizona Kidney Disease and Hypertension Centers (AKDHC) Phone: 1-602-997-0484 Online:

Radiology & Imaging Services: SPRDCUNM0oh0ULuHAOoA3INtSMTEGCnIh2LTAN__e2EwSMD_IST4:EDASeE_YA4T1ENQsP_TP-tQE6DKUN_EDD_I0ERDMU2GDNYi2E0aIMPBG0OW-1gSE9B015Cn_R050ECD1AoKD05R40A2EsR0IW6-0VtR0YD409i32_cD0E1234567890719IS010NI30HAG2mT410D46NPC6:a310SF9D|2g264/A9FR5M20:i4nHa-E411egWx440d:1~(iS1c0Da-06lCI)0A2R-D9156-9729 Online:

Additional Specialists & Facilities: For information on additional OptumCare specialists and facilities, please contact our Service Center or use the provider lookup on the OptumCare website. > providers > referral Lookup

Attached is your Health Insurance Member Identification Card (ID Card). Verify the information on your ID Card is correct. If you

Y0066_150609_163758 Accepted

companies, a Medicare Advantage organization

insured through UnitedHealthcare Company or one of its a liated

depends on the plan's contract renewal with

with a Medicare contract. Enrollment in the plan

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Attached is your Health Insurance Member Identi cation Card (ID Card). Verify the information on your ID Card is correct. If you

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PO Box 29830 Hot Springs, AR 71903-9830

Benefits Start Date: 01-01-2016

website listed on the back of to access plan information.

Attached is your Health Insurance Member Identi cation Card (ID Card). Verify the information on your ID Card is correct. If you need to make changes or have questions, please call the Customer Service phone number on the back of your ID Card. Always carry your ID Card with you. Visit the website listed on the back of your ID Card to access plan information. Plans are insured through UnitedHealthcare Insurance Company or one of its a liated companies, a Medicare Advantage organization with a Medicare contract. Enrollment in the plan depends on the plan's contract renewal with Medicare.

Y0066_150609_163758 Accepted

PO Box 29830 Hot Springs, AR 71903-9830

+

Benefits Start Date: 01-01-2016

UnitedHealthcare Plan ID Card

Example ID Card (Plan 1 & Plan 2)

D7

R3 ded

num

1

Health Plan (80840): 911-87726-04

Member ID: 0000000-01

Group Number: HCFAD7

Member:

PLAN CODE: RR3

2 SUBSCRIBER A BROWN

Dental Bene ts Included Payer ID:

PCP Name:

LIFE1

PROVIDER BROWN

PCP Phone: (000) 000-0000

3 OPTUM MED NETWK-LIFEPRINT

RxBin: 610097

RxPCN:

9999

Copay: PCP $10

ER $75

RxGrp:

SHCO

Spec $45

4 AARP MedicareComplete Plan 1 (HMO) w/Dental Platinum

H0609 PBP# 026

Customer Service Hours: 8 a.m. - 8 p.m. local time, 7 days a week

Health Plan (80840): 911-87726-04

WFoerbsMitee:mbersMember ID: 99w9w9w9.m9y9A-A9R9PMedicare.coGmroup Number: HCFAH4

Customer SeMrveicme:ber:

1-877-370-2843 TTY 711 PLAN CODE: R9Q

NurseLine: Behavioral

SUBSCRIBER1B-8R7O7-W36N5-7949

Health:

1-800-579-5222

TTY PaTTyYer

711 7ID11:

PCP Name:

LIFE1

6 5 For ProvidersPROwVwIDwE.

877-370-2845

Medical Claim PACddPrePssh: onLiefe:p(r9in9tP,9.O) .9B9o9x-496979709Las Vegas,NV 8911R4-x6B77in0: 610097

Dental ProvideMCrsoE: pDwaICywA:wPL.dCNbPpE.Tc$oW0mORK NAME ER $75

1-87RR7-xx81PG6C-r3p5N:96:

9999 SHCO

Spec $25

For Pharmacists1-877-889-6510

AARP MedicareComplete Plan 2 (HMO)

PharmacyClaiHm0s6O0p9tuPmBRPx #PO02B7ox29045,HotSprings,AR 71903

Y0066_150609_163758 Accepted

1 Customer Service Hours: 8 a.m. - 8 p.m. local time, 7 days a week

Health Plan (80840): 911-87726-04

WFoerbsMitee:mbersMember ID: 99w9w9w9.m9y9AA-9RP9Medicare.coGmroup Number: HCFAH4

Customer SeMrviecme:ber:

1-877-370-2843 TTY 711

PLAN CODE: R9Q

2 NurseLine:

Behavioral

SUBSCRIBER1-B8R77O-3W65N-7949

Health:

1-800-579-5222

TTY 711 PTaTyYer 7ID11:

PCP Name:

LIFE1

For ProvidersPROwVwIDwE.

877-370-2845

3 Medical Claim PAdCdPrePssh: oLnifee:p(ri9n9tP,9.O).9B9o9x4-96797909Las Vegas,NV 8911R4-x67B7i0n:

Dental ProviderMCs:oEpDwaICwyAw: PL.dCbNpPE.cTo$Wm0ORK NAME ER $75

1-877RR-8xx1PG6-C3rp5N9:6:

610097 9999

SHCO

Spec $25

For Pharmacists1-877-889-6510

4 AARP MedicareComplete Plan 2 (HMO)

PharmacyClaiHm0s6O0p9tuPmBRxPP#O0B2o7x29045,HotSprings,AR 71903

Medicare.

Visit the ID Card

Customer Service Hours: 8 a.m. - 8 p.m. local time, 7 days a week

For Members Website: Customer Service: NurseLine: Behavioral Health:

1-800-950-9355 TTY 711 1-877-365-7949 TTY 711 1-888-777-2735 TTY 711

6 5 For Providers 877-370-2845 Medical Claim Address: Lifeprint, P.O. Box 46770 Las Vegas, NV 89114-6770

For Pharmacists 1-877-889-6510 Pharmacy Claims OptumRx PO Box 29045, Hot Springs, AR 71903

1. Participating health plan logo 2. Payer ID 3. Network name 4. Plan name 5. Provider services toll free number 6. Medical claims address

Customer S

For Memb Website: Customer NurseLine Behaviora For Provi Medical Cla

For Pharma Pharmacy C

PROVIDER USE ONLY

? 2016 OptumCare Network in Arizona

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