OptumCare Quick Reference Guide

1 2016 Quick Reference Guide Welcome to OptumCare Network in Utah TM. Electronic Fund Transfer (EFT). OptumCare Network in Utah is an organization that has a history Optum offers EFT through ePayment. This can drastically reduce of improving quality of care, clinical outcomes, and member expense, shorten the reimbursement cycle, and streamline workflow. satisfaction through collaboration with the care delivery system. We work with Change Healthcare (formerly Emdeon) to provide OptumCare has local provider support services and offers payer remittance data electronically. You may call Change innovative value-based arrangements that align incentives with Healthcare at 1-866-506-2830 and select option 1 or sign up improved outcomes.

2 Online by visiting Client Number: 3059. Eligibility Contact information OptumCare Network has a contract with AARP insured through UnitedHealthcare in northern Utah in the following counties: Below are numbers and websites you can use to contact OptumCare Network or find information on related services. Salt Lake Davis Box Elder Cache Morgan Summit Tooele Utah Wasatch Weber OptumCare address: If a member has coverage through an AARP MedicareComplete 2525 Lake Park Boulevard, West Valley City, UT 84120. health plan, they are automatically a member in the network and can take advantage of what OptumCare Network in Utah has Note: Do not submit claims to this address. Please use the address to offer. under submitting a claim.

3 Participating plans OptumCare website: Use our website to log into the OptumCare Provider Portal - a tool giving you access to eligibility, submitting and viewing prior authorizations and claims information in real time. You'll also find our referral lookup tool, important forms, and many other Referrals resources online at Refer to > Browse OptumCare Locations >. OptumCare Service Center: Utah > Lookup Tool for Utah for a complete provider directory with eligible specialists. The primary care physician is responsible For date of service 1/1/15 and later, our OptumCare Service for coordinating all referrals. No written referral is required. Advocates are available to answer questions on topics such as provider search, claims, prior authorizations, eligibility, and more.

4 Submitting a claim Phone: 1-877-370-2845. Hours of operation: Monday-Saturday, 8 Follow these guidelines when submitting a claim through OptumCare for claims with a date of service 1/1/15 and later. Or you can contact the OptumCare Service Center through secure e-mail on the OptumCare Provider Portal For electronic submissions, use payer ID: LIFE1 at For paper submissions, use: For service issues prior to date of service 1/1/15, please call OptumCare Claims UnitedHealthcare at 1-877-842-3210. PO Box 46770. Las Vegas, NV 89114. Behavioral Health: Please send claims with a date of service prior to 1/1/15 to Optum Behavioral Health UnitedHealthcare. Phone: 1-800-579-5222. continued on back . Prior authorizations / Rx prior authorization : admission notification and referrals For UnitedHealthcare patients: Prior authorization and admission notification is required for Phone: 1-800-711-4555.

5 Certain services based on the patient's benefit plan. Fax: 1-800-527-0531. Online: > Health Care Professional >. Referrals are required for AARP MedicareComplete Plan 2 only. Prior Authorizations For more details, please visit the OptumCare website: > Browse OptumCare Locations > Utah > UnitedHealthcare Plan ID Card Provider Resources The below cards represent the plans OptumCare manages under UHC Medicare Advantage. You can confirm the plan is managed Listed below are numbers you may need to call to request prior by OptumCare by identifying the UHC Medicare assigned authorization : H number on the bottom left-hand corner of the card. Urgent and routine prior authorization / 1. Participating health plan logo Referrals and admission notification: 2.

6 Payer ID. RUN_DATE. DATA_SEQ_NO. CLIENT_NUMBER. UHG_TYPE. DOC_SEQ_ID. DOC_ID. NAME. MAILSET_NUMBER. CUSTMAPDGPS_KEY1. 960661912_KEY0. CUSTMAPDGPS_KEY2. CUSTMAPDGPS_KEY3. CUSTMAPDGPS_KEY4. CUSTMAPDGPS_KEY5. CUSTMAPDGPS_KEY6. CUSTMAPDGPS_KEY7. CUSTMAPDGPS_KEY8. CUSTMAPDGPS_KEY9. CUSTMAPDGPS_DIV_IND. DEBORRAH. DIG1 CARD. 20150116. 0000693. 0000001. 003106. CARD1. J0000693. MUNSON. 11:29:14. 42000. DEBORRAH. GPS/Medical 00. 20150101. 960661912. 960661912~00 CARD1. SLC RUN_DATE. DATA_SEQ_NO. CLIENT_NUMBER. UHG_TYPE. DOC_SEQ_ID. DOC_ID. NAME. MAILSET_NUMBER. CUSTMAPDGPS_KEY1. 966864364_KEY0. CUSTMAPDGPS_KEY2. CUSTMAPDGPS_KEY3. CUSTMAPDGPS_KEY4. CUSTMAPDGPS_KEY5. CUSTMAPDGPS_KEY6. CUSTMAPDGPS_KEY7. CUSTMAPDGPS_KEY8.

7 CUSTMAPDGPS_KEY9. CUSTMAPDGPS_DIV_IND. WILLIAM. DIG1 CARD. 20150116. 0000022. 0000001. P 003106. CARD1. TEW. 0000022. 11:30:32. 42022. WILLIAM. GPS/Medical 00. 20150101. 966864364. 966864364~00 CARD1. SLC RUN_DATE. DATA_SEQ_NO. CLIENT_NUMBER. UHG_TYPE. DOC_SEQ_ID. DOC_ID. NAME. MAILSET_NUMBER. CUSTMAPDGPS_KEY1. 958753647_KEY0. CUSTMAPDGPS_KEY2. CUSTMAPDGPS_KEY3. CUSTMAPDGPS_KEY4. CUSTMAPDGPS_KEY5. CUSTMAPDGPS_KEY6. CUSTMAPDGPS_KEY7. CUSTMAPDGPS_KEY8. CUSTMAPDGPS_KEY9. CUSTMAPDGPS_DIV_IND. JAMES. DIG1 CARD. 20160111. 0002303. B SCHNAIDT. 0000001. 003106. CARD1. 0002303. 15:01:44. 42020. JAMES. GPS/Medical 00. 20160101. 958753647. 958753647~00 CARD1. SLC. 3. Network name Phone: 1-877-370-2845 4. Plan name Fax: 1-888-992-2809 5.

8 Provider services toll-free number Online: > Browse OptumCare Locations > Utah 6. Medical claims address make changes or have questions, please make changes or have questions, please Benefits Start Date: 01-01-2015. back of your ID Card. Always carry your ID Card Benefits Start Date: 01-01-2016. Benefits Start Date: 01-01-2015. call the Customer Service phone number on the a Medicare Advantage organization back of your ID Card. Always carry your ID Card > Provider Resources with a Medicare contract. Enrollment in the plan 7. UHC Medicare assigned H contract number call the Customer Service phone number on the a Medicare Advantage organization with a Medicare contract. Enrollment in the plan Hot Springs, AR 71903-9830.

9 PO Box 29830. Hot Springs, AR 71903-9830. PO Box 29830. Hot Springs, AR 71903-9830. PO Box 29830. on the on your ID Card is correct. If you 8. Referral Required Indicator Plans are insured through UnitedHealthcare depends on the plan's contract renewal with on the on your ID Card is correct. If you Plans are insured through UnitedHealthcare depends on the plan's contract renewal with If you is your Health Insurance Member If you is your Health Insurance Member Visit the website listed on the back of your the plan Company or one of its affiliated Visit the website listed on the back of your in the planCompany or one of its affiliated please Card (ID Card). Verify the please Card (ID Card). Verify the ID Card to access plan information.

10 ID Card to access plan information. Y0066_141027_085959 Accepted Y0066_141027_085959 Accepted RUN_DATE. DATA_SEQ_NO. CLIENT_NUMBER. UHG_TYPE. DOC_SEQ_ID. DOC_ID. NAME. MAILSET_NUMBER. CUSTMAPDGPS_KEY1. 966864364_KEY0. CUSTMAPDGPS_KEY2. CUSTMAPDGPS_KEY3. CUSTMAPDGPS_KEY4. CUSTMAPDGPS_KEY5. CUSTMAPDGPS_KEY6. CUSTMAPDGPS_KEY7. CUSTMAPDGPS_KEY8. CUSTMAPDGPS_KEY9. CUSTMAPDGPS_DIV_IND. WILLIAM. DIG1 CARD. 20150116. 0000022. 0000001. P 003106. CARD1. TEW. 0000022. 11:30:32. 42022. WILLIAM. GPS/Medical 00. 20150101. 966864364. 966864364~00 CARD1. SLC RUN_DATE. DATA_SEQ_NO. CLIENT_NUMBER. UHG_TYPE. DOC_SEQ_ID. DOC_ID. NAME. MAILSET_NUMBER. CUSTMAPDGPS_KEY1. 958753647_KEY0. CUSTMAPDGPS_KEY2. CUSTMAPDGPS_KEY3. CUSTMAPDGPS_KEY4.