Welcome to UnitedHealthcare 2016 Overview for Lakeland Care Network Payor Conference 10-19-2016

1. Welcome to UnitedHealthcare 2016Overview for Lakeland Care Network Payor Conference 10-19-2016

2. AGENDA Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group. • Link • Service Model • Advance Notification/Prior Authorization • Resources

3. UnitedHealthcareOnline.comProvider Portal Link Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

4. Link cont.… Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group. Link: The New Gateway to UnitedHealthcare’s Online Care Provider Tools To get started, register to get your Optum ID at www.unitedhealthcareonline.com. Use your Optum ID to sign-in to access Link: Benefits & Eligibility eligibilityLink - Check member eligibility & print ID card - Review cost share, deductible or out-of-pocket responsibility - View preventive care opportunities for some members - Coverage details and limits specific to each benefit plan Claim Status & Claim Reconsideration claimsLink - View claims information for multiple UnitedHealthcare plans - Access letters, remittance advice documents & reimbursement policies - Flag claims for future viewing - Create a new claim reconsideration request or view an existing one from the claim detail screen - Get real-time status updates and adjuster comments for reconsideration requests Prior Authorization & Notification - Determine whether notification or prior authorization is needed - Submit notification or initiate a prior authorization request - Check status of previously submitted notification or prior authorization requests

5. Introducing eligiblityLink and claimsLink. The newest enhancement to UnitedHealthcare’s online tools Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

6. Tune in to what’s new Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

7. UHC On Air Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

8. UHC On Air Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

9. Service Model: Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group. Customer Service: #877-842-3210 Commercial #800-903-5253 Community Plan - you will be given a reference number - you will be given a reference number EDI # 87726 EDI # 95467 Claim Status & Claim Reconsideration claimsLink - You will be given a ticket number PTPCR-XXXXX. For a claims failure please reach out to your Provider Advocate and provide the Reference number or PTPCR number Benefits & Eligibility eligibilityLink Appeals: Commercial Community Plan UnitedHealthcare Provider Appeals UnitedHealthcare Community Plan P.O. Box 30559 Attn: Claims Administrative Appeals Salt Lake City, UT 84130-0575 P.O. Box 30991 Reminder: an appeal is the last attempt for claims resolution Salt Lake City, UT 84130-0991 Non-urgent Appeals fax #801-994-1082 Urgent Appeals fax #801-994-1261 Level 1 appeal – filed within 180 days from paid date of claim Level 2 appeal – 60 days of receipt of the Level 1 decision

10. New National Drug Code (NDC) Requirement Policy Effective January 1, 2017 a new National Drug Code (NDC) Requirement Reimbursement Policy will be implemented. The NDC number, quantity and the unit of measure will be enforced as well as the corresponding HCPCS and CPT codes and units administered for each code. Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

11. Advance Notification Requirements – Physician Commercial Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group. • Providers are responsible for advance notification for certain planned services. - Notification is required at least five (5) business days prior to the planned service date (unless otherwise specified within the Notification List in Administrative Guide). - Notification for home health services is required within forty-eight hours after physician's order. - If services are planned less than five (5) business days prior to the service date, notification is required as soon as the service is scheduled. • Complete Advance Notification list is located on www.unitedhealthcareonline.com > clinician resources > Advanced Admission Notification Requirements – Please note this is updated several times a year. • 2017 changes - Commercial – • Specialty Medication • All Savers Insurance Company group #908867 & 908868 • Submission Methods • -Prior Authorization and Notification Link application • UnitedHealthcareOnline.com – • Notifications / Prior Authorizations / Notification Submission • Phone – see Customer’s healthcare ID card • Fax – Commercial: 866-756-9733 • Medicare Advantage: 800-676-4798 • Clinical coverage review based on medical necessity may be required at time of submission

12. Advance Notification Requirements – FacilityCommercial Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group. • Admission Notifications • All Admissions require notifications within: • 24 hours of weekday admission • By 5:00 pm next business day for weekend and federal holidays • Inpatient or Outpatient services on the Advance Notification list • Facility must confirm prior to service that: • Coverage Approval is on file • Medical Necessity review is complete (2011 COC) • If approval is denied – Initiate pre-service conversation & waiver

13. Radiology Notification – Commercial Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group. • Radiology Notification is a prior notification process for selective outpatient, advanced imaging procedures • UnitedHealthcareOnline.com > Clinician Resources > Radiology > Radiology Notification Program > Reference Materials • Code crosswalk available on: www.unitedhealthcareonline.com

14. Cardiology Notification – Commercial The Cardiology Notification Program is a notification protocol required for participating physicians for select inpatient, outpatient, and office-based procedures prior to performance UnitedHealthcareOnline.com > Clinician Resources > Cardiology > Cardiology Notification Program > Reference Materials Code crosswalk available on UnitedHealthcareOnline.com

15. Advance Notification Requirements - Facility Community Plan Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group. • Providers are responsible for advance notification for certain planned services. • All services rendered by a non-contracted physician, facility, or other non-contracted health care provider must have prior authorization (exceptions: Orthopedic Physician Services and Obstetrical Physician Services) • All Inpatient Services require an authorization • Notification Only: Routine OB/Delivery (Not exceeding 2 day LOS for vaginal and 4 day LOS for cesarean deliveries) • OB and Newborn Confinements Exceeding routine LOS • All NICU admissions • UnitedHealthcare Community Plan follows CMS OPPS “Inpatient Only” list for surgical procedures • Please visit www.unitedhealthcarecommunityplan.com for most current list of required codes and additional requirements • Admission Notifications • All Admissions require notifications within: • 24 hours of weekday admission • Next business day for weekend and federal holidays • Inpatient or Outpatient services on the Prior Authorization & Precertification List • * UHC Community Plan must be notified no less than 3 business days prior to the planned service date

16. Notification Requirements: Community Plan Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group. • Complete Prior Authorization & Precertification List is posted on www.UHCCommunityPlan.com > Find Plans By State (click on the appropriate state) > If you are a Health Professional > Precert / Prior Authorization Lists • Submission Methods • Referral/Certification: • Phone – 800-903-5253 • Fax – 855-225-9847 • Admission Notification: • -Phone - 800-696-8735 • -Fax – 855-225-9847

17. Resources: UnitedHealthcare Advocates: Physician Advocate – Darin Yates darin_yates@uhc.com #269-337-9450 Hospital Advocate – Chris Webster christine_e_webster@uhc.com #248-331-4381 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group. • UnitedHealthcareOnline.com • Administrative Guides • Updated annually • Available online • Network Bulletin (newsletter) • Published the 1st of every month • Alerts you to any changes in policies or protocols and updates to the Administrative Guide • To receive the Network Bulletin by email - enroll on the website home page unde Register

18. QUESTIONS Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.