Home Health Updates

Home Health Updates for Prior Auth and Bill Type 320

When OMN entered the market January 1, 2015, the standard Prior Authorization process for Home Health Care services was not enforced due to a large volume of cases transitioning from UnitedHealthcare (UHC) to OMN and to facilitate an uninterrupted transition for our members and providers into our Medical Management program.

Service or Claims Questions

For service or claim questions our Optum Medical Network Service Advocates are available to answer questions on topics such as provider search, claims, prior authorizations, eligibility, and more. Please contact them at (877) 370-2845.

Hours of Operation:
Monday – Saturday, 8:00 am – 8:00 pm

Or you can contact the Optum Service Center through secure e-mail by logging into the Optum Medical Network Provider Portal on the OptumMedicalNetwork.com home page.

EFT

Optum offers Electronic Funds Transfers (EFT) through Emdeon to provide payer remittance data and direct deposit. This can drastically reduce expense, streamline workflow and shorten reimbursement cycle. You may call Emdeon at (866) 506-2830 and select option 1 or sign up by visiting emdeon.com/eft.

Optum Client: #3059
Payer ID:LIFE1

UnitedHealthcare Gatekeeper Plan

In 2015, UnitedHealthcare launched a $0 premium HMO plan, in addition to their existing HMO plan. These plans are very similar in benefits, however, the $0 premium plan, referred to as the “gatekeeper plan” requires a referral. The idea behind this plan is to ensure that a patient recognizes the importance of their relationship with their primary care provider.

Delegated Relationship with Optum Medical Network in Utah Effective January 1, 2015

Effective January 1, 2015, Optum Medical Network will be delegated for claims payment and utilization management for all UnitedHealthcare Group Medicare Advantage HMO and AARP® Medicare Complete benefit plans in Utah. Optum Medical Network provides local support services and offers innovative value-based arrangements that align incentives with improved outcomes.

The following information will change on UnitedHealthcare Medicare Advantage member identification (ID) cards as of Jan. 1:

Information on Utilization Management

Affirmative Statement Regarding Incentives

Optum Medical Network’s core values of integrity and compassion dictate that we deliver the most effective care possible to every patient. This principle should be the guiding force behind all the decisions we make when it comes to patient care, including those surrounding utilization management.

Therefore, we are sharing this Affirmative Statement about incentives (specifically relating to Utilization Management).

Clinical Guidelines

Disease specific clinical guidelines have been added to the website for the following diagnoses: HTN, Cholesterol, COPD, Heart Failure and Diabetes. We recommend using these best practice guidelines to assist in the management of your patients. These guidelines are nationally approved for the management of patients.

Prior Authorization List

Optum Medical Network has posted a list of procedures that require prior authorization. This is not an all-inclusive list and is subject to change. Please note that inclusion of items or services in this list does not indicate benefit coverage. You should verify benefits prior to requesting authorization.

Payment for authorized services is contingent upon verification of eligibility for benefits, the benefits available in the member’s plan, the applicable contractual limitations, restrictions and exclusions.

Prior Authorization is not required for emergency or urgently needed services.

Click here to view a list of Prior Authorizations

Claims Submission

Claims for your UnitedHealthcare Medicare Advantage members for Dates of Service January 1, 2015 going forward should be submitted with the Payer ID: LIFE1 through Optum Medical Network’s preferred method of electronic claim submission known as Electronic Data Interchange (EDI).

EDI is the computer-to-computer transfer of data transactions and information between trading partners (payers and providers). EDI is a fast, inexpensive and safe method for automating the business practices that take place on a daily basis. There is no charge for submitting claims electronically to Optum Medical Network.

Electronic claims submission allows the provider to eliminate the hassle and expense of printing, stuffing and mailing your claims to Optum Medical Network. It substantially reduces the delivery, processing and payment time of claims. There is no charge for submitting claims electronically. Providers are able to use any major clearinghouse.

Prior Authorization List

Optum Medical Network has posted a list of procedures that require prior authorization. This is not an all-inclusive list and is subject to change. Please note that inclusion of items or services in this list does not indicate benefit coverage. You should verify benefits prior to requesting authorization.

Payment for authorized services is contingent upon verification of eligibility for benefits, the benefits available in the member’s plan, the applicable contractual limitations, restrictions and exclusions.

Prior Authorization is not required for emergency or urgently needed services.

Click here to view a list of Prior Authorizations