Provider Quick Reference Guide - Better Health

1 Provider Quick Reference GuideHelpful Numbers forAssisting MembersWe know from time to time members seek information about the plan from their providers. Below is contact information to assist you in responding to those ServicesProvider: TMS 1-866-201-9970 Members must arrange for transportation 72 hours prior to their medical Services(also printed on the Member s ID card) 1-800-514-4561 For information and inquiries about enrollment Better Health : 1-855-813-6619, TTY 711 Choice Counseling: 1-877-711-3662 Submitting Claims and Encounters Electronic submission (EDI) AvailityBetter Health Payor ID# 01508 Emdeon Better Health Payor ID# 20488 Provider ServicesPhone NumbersProvider Services1-877-915-0551 U Eligibility and Verification, Prompt 1U Authorizations and Pre-Certifications, Prompt 2U Claims Status, Prompt 3U Other Provider Questions, Prompt 4U Pharmacy Department, Prompt 5U Case Management, Prompt 6 U Inpatient/Discharge Planning, Prompt 7 Fax NumbersUtilization Management - Referrals1-800-283-2117 Pharmacy DepartmentPrior Authorizations1-877-577-9045 Better Health Fraud and Abuse Hotline1-877-253-9251 Paper submission Better Health PO Box 211665 Eagan.

2 MN 55121 Important reminders U > V `i * (National Provider Identification #) U > V `i /> U > V `i i * >Vi v -i Vi *"- 6-06-2014 Prior Authorizations SERVICES THAT REQUIRE PRIOR AUTHORIZATIONR equests for Prior Authorization should be submitted via our Provider Portal, or on the Prior Authorization Form, via fax. / i v > > >L i i > ` i * `i -i Vi InstructionsElectronic submission1. Li i i> v `> V V * `i > i v i >}i 2. V i * `i * > 3. Log in to the portal with your User ID and password. First-time users must register by clicking on * `i ,i} > i iv `i v i >}i 4.

3 For outpatient services V - L ,ivi > > v i i i } side of the page to begin the process. For inpatient services V - L > i > v i i i } side of the page to begin the submission via fax1. Li i i> v `> V V * `i > i v i >}i 2. -V ` i >}i * `i 3. V i i i> ,ivi > > 4. Print and complete the Fax the completed form to Better Health at 1-800-283-2117. -/ / 1 }i i i ] i> i V> i i i i> * i i wV> i > n x xx ] " NO PRIOR AUTHORIZATION REQUIRED Use the Quick Authorization Form (QAF)No Prior Authorization is required for items and services listed on the Quick Authorization Form (QAF).

4 / i + > ` v \ - iV > > i` "vv Vi * Vi` i ii - > ` } Diagnostic Facilities. It is for use by participating providers ONLY. InstructionsFax the completed QAF directly to the Specialist and provide a copy to the member during the same office visit. / i + V> Li v ` i V `i` * `i -i Vi / i i no need to s L i + i > * i> i i > i + v "/ v i Vi performed in a you have any questions about claims submission, authorizations or encounters please contact your Provider Network Consultant or call Provider Services at 1-877-915-0551. For inpatient services side of the page to begin the process.

5 Exclusive Participating Provider NetworksPlease contact them directly to coordinate services/ > V `i v } > ` V ` > } i Vi v i i i> i Li ] Li > v exclusive participating Provider networks that are contracted with our plan. Any referrals outside of these networks are considered referrals to non-participating a participating PCP for Better Health , it is critical that your physicians and staff members refer within the Plan s within the network will ensure that members receive the best possible attention and service.

6 Our Provider ,i > i > i > i > 1 > > >}i i i > i Li } V > Vi > relates to referrals outside of the Better Health network. Please contact the networks listed below to coordinate V >V i` i i Vi / v > > Li i` > Li i i> y `> V Eligibility, Claim Status, Referral & Authorizations, Provider Directory and Provider Manual can be accessed through the Better Health website at HealthDiabetic Supplies Durable Medical Equipment,HHC & InfusionHearing, i 6 Laboratory ServicesVision/Ophthalmology/ > > ServiceNeighborhood DiabetesUnivitaHearUSAP remier Eye CareQuest DiagnosticsFlorida EyeCareExclusive ProviderTelephone/FaxP: 1-800-221-5487, Option 5F: 305-279-4344P: 1-866-784-5647 DentalDentaQuestP: 1-877-468-5581P.

7 1-888-914-2201F: 1-888-914-2202P: 1-800-731-3277, Option 1P: 1-800-738-1889P: 1-866-697-8378, Option 1P: 1-877-359-9257/ -P: 1-866-201-9970 Psychcare p B NOTES: 5 6 P