NEBRASKA Spring AAHAM

1. NEBRASKA Spring AAHAM Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.

2. What’s New in Nebraska UHC0048_061009

3. TODAY’S AGENDA INCLUDES: ICD-10 Optum Cloud Advance Notification Contact Info Enhanced HIPAA Edits PATH Member Rewards Advocate Hotline United Healthcare Military & Veterans/TRICARE Q&A UHC0048_061009

4. ICD-10 On Hold To support our providers during this transition, UnitedHealthcare offers the following tools at UnitedHealthcareOnline.comto assist you in becoming ICD-10 compliant for 2015: • ICD-10 Education - on-demand educational resources designed to provide general information regarding ICD-10 and the implementation process. • ICD-10 Tools - in collaboration with the American Academy of Professional Coders (AAPC), the largest coding organization in the country, we have created a suite of tools including ICD- 10 code selection decision trees and detailed clinical documentation improvement webinars. • Submit questionsto ICD10Questions@uhc.com. Please allow up to15 business days for a response. Additional resources can be found on cms.gov/ICD10.

5. OPTUM CLOUD DASHBOARD Optum Cloud Dashboard - Is a cloud-based website that has new features and functionality which allows providers to submit claim reconsideration requests electronically with attachments. New Enhancements: • The Eligibility & Benefits center- check eligibility, get in and out of network benefit info, review coordination of benefits info and review copay and coinsurance • Claims Management- flag claims for automatic review and view line level and claim level remark codes

6. ADVANCE NOTIFICATION LIST • Advance Notification List - The Advance Notification list of procedure codes has moved online for your convenience at UnitedHealthcare Online.com Clinician Resources > Advance & Admission Notification Requirements.

7. Enhanced HIPAA Edits to be Applied to Claim Submissions • Effective April 23, 2014, UnitedHealthcare will apply an enhanced level of HIPAA edits to professional (837p) and institutional (837i) claims submitted electronically to most UnitedHealthcare and affiliate payer IDs.* • Because the new edits will be applied on a pre-adjudication basis, an increase in the number of claim rejections may occur. This will enable you to identify and correct rejected information prior to the claim’s acceptance into our adjudication system for processing. • The benefit will be fewer denied claims and less interruption to revenue streams. • The primary impact to you will come from edits that will validate code sets (such as diagnosis, procedure modifier and national drug codes) at a pre-adjudication level. The complete list of enhanced edits has been distributed to clearinghouses and software vendors.

12. Contact Us Nebraska_PR_team@UHC.com UnitedHealthcareonline.com UHC0048_061009

13. TRICARE Updates UnitedHealthcare Military & Veterans UHC0048_061009

14. Updated Provider Handbook The UnitedHealthcare Military & Veterans TRICARE Provider Handbook has been updated and the new edition is available online at www.uhcmilitarywest.com. The changes in the Handbook will be effective on July 1, 2014 for currently contracted providers and immediately for providers newly contracted on or after April 1, 2014. A summary list of changes to the Handbook has also been posted for your convenience. UHC0048_061009

15. Submit Referrals/Authorization Online • To Submit a Referral or Authorization Request: • Log in to your UHCMilitaryWest.comaccount.** • From the authenticated Provider Home Page, click on the Submit Referral or Authorization Request link. • Updates include selecting Episodes of Care and adding attachments • ** Only UnitedHealthcare Military & Veterans in-network, and TRICARE-contracted providers with a UHCMilitaryWest.com account, can submit referrals or authorizations online.

16. Prior Authorization Changes Changes to the PAL: Durable Medical Equipment over $150 Orthotics Prosthetics Questionable Services List List of Codes Removed: The list of codes requiring Prior Authorization has been removed as it was not a comprehensive list Please utilize the narrative Prior Authorization List and also reference the of Questionable Services List to determine what requires Prior Authorization UHC0048_061009

17. DME Authorization Requirements Pricing Criteria Authorization needed for all Durable Medical Equipment (DME) greater than $150.00 DME Tip Sheet: • A detailed DME tip sheet can be found on www.uhcmilitarywest.com – Providers > Claims > Durable Medical Equipment Claims Filing Tip Sheet REQUIRED ITEMS which must be on all DME authorization requests: • patient’s name • procedure code(s) • diagnosis code(s) • beginning and ending dates equipment is needed • physician’s statement of prognosis • valid physician signature – not certified NP or PA

18. DME Authorization Requirements Authorizations satisfy Certification of Medical Necessity (CMN) requirements if DME item costs $150 - $2000 • Exceptions: five (5) items require additional clinical information through submission of the appropriate CMS form http://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/CMS-Forms-List.html Proof of Medical Necessity is required for authorization if DME item costs over $2000 • Be sure to include: • “required item list” (patient name, diagnosis codes, procedure codes, etc.) and • supporting clinical information justifying the need

19. DME Upgrades DME upgrade is covered when medically necessary: • Item otherwise meets the DME benefit requirement • Medically necessary • Prescription specifically states the medical reason why upgrade is necessary (ex: the beneficiary does not have the physical strength or balance required to lift a standard walker and, therefore, one with wheels is required) DME upgrade for deluxe, luxury, or immaterial feature device when beneficiary preference (not medically necessary): • TRICARE-allowed amount for base model may be applied to the upgraded equipment if item otherwise meets the DME benefit requirement • The beneficiary will be solely responsible for the difference between the base model (standard equipment) allowed amount and provider’s billed charges. • Upgrade must be within the range of services that are appropriate for the medical condition When a beneficiary prefers to upgrade: • Provider may collect charges that exceed the cost the government would pay for the standard equipment only when: • Beneficiary given written notice the upgrade has been (or may be) denied and • Beneficiary agrees in writing to be financially liable for the difference between charges for the upgraded item and the charges for the standard item.

20. PGBA’s Website: myTRICARE.com myTRICARE.com Functionality • Verify Eligibility (including PCM, program, deductible, and OHI information) • Check Referral/Authorization Status • Check claim status • View and print remits • Claim Data Reports • AskUs confidential questions online • Validate provider file demographics • Validate/submit NPI numbers • Submit your claims via XPressClaim • Unlimited number of users allowed to register per account

21. myTRICARE.com AskUs Feature • No need to telephone PGBA; ask questions online • Receive a prompt reply in your personal, secure myTRICARE mailbox

22. Thank You For Your Participation!

23. Questions UHC0048_061009