Quick reference guide: Connecticut

1 Welcome to OptumCare Network of Connecticut OptumCare Network of Connecticut (OCNCT) is an Independent Physician s Association (IPA) with a local management team. We offer a full range of services to assist physicians and other providers in their managed care and business operations. This Quick reference guide provides the most important information you ll need when working with OCNCT patients. Eligibility OCNCT currently has an exclusive contract with the participating plan listed below for patients in Connecticut .

2 Patients can take advantage of what OCNCT has to offer if they select a primary care physician (PCP) from the OptumCare Network, and they have coverage through the listed participating Medicare Advantage can check member eligibility in NAMMNet Express (NE), available through the OptumCare Provider Portal*: > Click on Claims, Eligibility, Prior Authorizations and Referrals plan Plan name: UnitedHealthcare Medicare Complete Plan 3 (HMO)CMS contract: H0755 PBP# 033 Group numbers: 27100 OR 27150 Members that have an OCNCT PCP will have one of the above listed group numbers on their member authorizations and referralsPrior authorization (PAs) and referrals are required for certain services based on the patient s benefi t plan.

3 Refer to the 2018 Provider Manual for additional information. PAs/referrals should be done prior to scheduling appointment. An active referral is good for one (1) initial consult and two (2) follow-up visits in a ninety (90) day period. The specialist or PCP can order subsequent visits, if clinically necessary. If the PCP requires more visits a new referral must be entered for these. OR if the PCP wants the referral extended beyond 90 days, a new order must be entered. Listed below are the numbers/online application you may need to use to request prior authorization or make a referral.

4 Online: NAMMNet Express (NE) available through the OptumCare Provider Portal*: > Click on Claims, Eligibility, Prior Authorizations and Referrals tile. Fax: 1-855-268-2904 Phone: 1-888-556-7048 for urgent referral onlyPhone line business hours are Mon. Sat., 8 4 , ESTR efer to for a directory of eligible specialists. Referrals will be returned to providers via the method they were submitted.*To request access to the provider portal, contact the OCNCT network coordinator at Quick reference guide : ConnecticutUpdated April 2018 PROVIDER USE ONLY Submitting a claim Follow these guidelines when submitting a claim through OptumCare.

5 electronic submissions Use payer ID, E3287 Paper submissionsOptumCare Network of Connecticut Box 471 Farmington, CT 06034-0471 Submitting a claim corrections Corrected claims can be submitted via paper or electronically by following the guidelines below. Professional claims CMS-1500 paper claim identifiers 1. Box 22 (Resubmission Code): Required if sending a replacement or void to a prior claim. List the applicable resubmission code in the left-hand portion of box 22: a. 7 Replacement of prior claimb.

6 8 Void/Cancel of prior claim2. Box 22 (Original Ref No.): List the prior claim number generated by claims UB-04 paper claim identifiers 1. Field 4 (Type of Bill):a. 0XX7 = Replacement of prior claim: This type of bill is used when a specific claim needs to be restated in its entirety, except for the identifying information. The original bill is considered null and void, and the information on this bill completely replaces the previous 0XX8 = Void/Cancel of a prior claim: This code indicates that this claim eliminates and cancels a previously submitted Field 64 (Document Control Number): Required if sending a replacement or void of a prior claim.

7 List the previous claim contact informationBelow are numbers and websites you can use to contact OptumCare or find information on related website provider portalUse our OptumCare Provider Portal, a tool giving you access to eligibility, prior authorization and claims information in real time. You ll also find our referral lookup tool, important forms, and many other resources at OptumCare websiteVisit can filter documents by choosing Connecticut on the left side. Refer to the provider portal ( ) or our website ( ) to download the following documents:1.

8 electronic fund transfer (EFT) 2. electronic Remittance Advice (ERA) 3. Provider Dispute Resolution (PDR) form4. Provider Referral form5. Prior Authorization Form for Rx injectablesHelp desk: 1-888-556-7048, Mon. Sat., 8 4 , ESTP ress 1 for claims information Press 2 for existing prior authorization information Press 3 for new prior authorization information Behavioral health: 1-800-985-2596, Mon. Sat., 8 8 , ESTTo find behavioral health providers, call the number above, or visit: # help line: 1-888-832-0963, Mon.

9 Sat., 8 8 , ESTN etwork manager: _____Phone: _____Network liaison: _____Phone: _____ PROVIDER USE ONLY 74410-042018 2018 OptumCare Network of Connecticut