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.
RDCUNM72ULHAOAFo4INSMTEGCoIp3LTAN__r9EtSMD_uIST8mEDSSE_YAm7TTEQNoP_TPEQmErKU_NEDVe_IEDMeUE2GDNYdd0IMPABG0eO1iScEBt01W6C_aaR00EC0AKDli0InR3l0A1LsER0I4e0L,VR0YD08t3I7p_D0123456789A0w16I0l10NMe7HSG02o31aT20D6PCS4r:sE415kSF8e2V36./A6c5ME90:v4Do-81i8esm70idt1~it>c0ha0eplCrOAoRvpiDtdu1emr rCeasoreuwrceesbs>ite: prior authorizations
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
RDCUNM00ULHAOA3INSMTEGCI2LTAN__2ESMD_IST4EDASE_YA4TENQP_TPQEDKU_NED_IERDMU2GDNYE0IMPBG0OW1SEB015C_R00ECD1AKD0R40A2ER0IW60VR0YD0932_D0E123456789019IS010N0HAG2T410D6NPC6:310SF9D2264/A9R5M20:4H-E411eW440d1~ic0a0lCARD1
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
IcPnlosamunrpsaananriceee is,nCsoaurmMepedadtinhcyraororuegoAhndevUaonfintitteasdgaHeffeiolairltagdtwMhiaeetecnpdihdaierzacneaatdirMseo.enodinctarhee
IyPlnosauunrrsanarcee
Attached is your Health Insurance Member Identi cation Card (ID Card). Verify the information on your ID Card is correct. If you
iInAndtfeteoearndtcifmthiaoectidatoimisnaoknyoeonCucyarhroadHunr(eIgIaleDtDshCCIoaranrrshdd)ua.eobwImaiaefnltblcesyh,ektdroyhptouloefoeu.yCamousasuetkroeIDmcehrCaarnSgde.revsiAcloerwahpyashvoecnaerqruyneusytimooubrnersI,DopnlCtearahsdee cbwiaatllchtkyhooefu.yCouusrt IoDmeCrarSde.rviAlcweapyhsocnaerrnyuymoIVbuiDresirItCDoatrnhCdteahtrewodeabcsciteseslistpleadn ionnftorhemabtaicokn.of your
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
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related download
- how do i submit the disenrollment request
- member identification card
- electronic funds transfer eft authorization form
- redeem rewards even faster redeem rewards even faster
- to register navigate to and click register
- optumcare quick reference guide arizona
- getting to know your prescription drug list
- r enew by unitedhealthcare home
Related searches
- free excel quick reference sheet
- hospice eligibility quick reference guide
- sba loan quick reference guide
- excel vba quick reference pdf
- excel 2010 quick reference card
- sba quick reference guide 2019
- mla quick reference sheet
- excel 2016 quick reference pdf
- excel quick reference cards 2019
- apa quick reference sheet
- icd 10 quick reference sheets
- icd 10 quick reference list