1. MEDIA Fall Seminar November 2016 Presenters:
Sylvia Hromek, Network Account Manager
Lisa Saulle, Provider Advocate

2. Agenda Credentialing and Contracting
Network Contacts and Contract Analyst Team
Participating Provider Laboratory and Pathology Protocol
Link
Eligibility, Authorizations, Claims Management and Claims Reconsideration
Annual Model of Care Training
Introducing: UHC On Air
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3. Ask the Carrier 4/4/12
Credentialing
Before a care provider’s participation agreement can be finalized, applications must be approved by our national credentialing center.
Check that your information with CAQH.org is updated and you have authorized UnitedHealthcare to access your information.
Physicians should contact our national credentialing center to verify or report if physicians within your organization are credentialed with us in New York State at
Send a completed request for participation form and W-9 by fax to
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4. Contracting
Once credentialing is completed, contact your UnitedHealthcare network account manager to verify a participation agreement is being sent to you.
To be a network care provider, a participation agreement must be on file that is signed by both parties with an effective date.
The effective date begins at least 30 days after the date when the agreement has been executed by both parties, and is the first day of the next calendar month. Please note: there may be alternates used in the contract to establish the effective date. Refer to your fully executed contract to determine the contract’s effective date.
A care provider is not part of our network until both the credentialing and contracting processes are completed.
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5. Network Contacts
Your local network team is available to answer questions regarding participation in our network, contracting, credentialing, fee schedules, the administrative guide, policies and procedures. Please questions to Include physician name, contact name, contact phone number, tracking number, TIN and a brief description of issue. The team will respond to your question as soon as possible, and acknowledge your inquiry within 48 hours.
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6. Contract Analyst Team (CAT)
When updating information about your practice, you can now the new contract analyst team at address the following four scenarios:
You receive an automated from stating the status of your request is either “Resolved-Closed” or “Resolved-Partially Completed.” We will take the necessary action to ensure your request is fully completed when you forward the reference/PR number from that to
If it has been more than 90 days since you received a PR tracking number from and you still have not received a “Resolved” from our system, please forward the PR number to and we will escalate the request.
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7. Contract Analyst Team (cont’d)
You receive an automated from that says the status of your request is “Resolved-Completed.” Please contact Provider Services at to verify the request was completed correctly. If you find your request was not completed correctly, you may forward the PR reference number to Please include information about what Provider Services told you, include the reference number and ask the CAT Team to research/audit the PR reference number.
You need to contact Provider Services to validate a care provider’s current contract/participation status but have not gotten an answer when calling
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8. Participating Provider Laboratory and Pathology Protocol
Effective Sept. 1, 2016, the Participating Provider Laboratory and Pathology Protocol requires UnitedHealthcare network physicians and other qualified health care professionals to obtain consent from UnitedHealthcare members before referring them to or using non-network laboratories or pathologists for their care.
This includes:
Specimens collected in the office are sent to a non-participating laboratory/pathologist for processing; OR
Members are given a prescription, requisition or other form to obtain laboratory/pathology services outside of your office.
The form is not required when specimens are collected in-office and sent to a network laboratory/pathologist for processing.
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9. Link and Online Tools
Link is your new gateway to UnitedHealthcare’s online tools. It includes many of the same applications as Optum Cloud Dashboard, but with a new interface.
Take advantage of free instructor-led trainings, previously recorded on-demand sessions, slide presentations and more at UnitedHealthcare.com > Tools & Resources > Training & Education.
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10. Accessing Link UnitedHealthcareOnline.com is your entry to Link.
To complete transactions using applications on Link, please sign in to UnitedHealthcareOnline.com using your Optum ID.
If you have questions, please call the Optum Support Center at
Users will sign in with their Optum ID
If they do not know their Optum ID, it will be provided to them when they log in with their UnitedHealthcareOnline ID
If the user does not have an Optum ID, they can register for one after clicking “Sign In” on the Optum ID side.
Password Owners and Administrators can identify the user’s Optum ID in User ID and PW Management.
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11. Annual Model of Care Training
Ask the Carrier 4/4/12
Annual Model of Care Training
The Centers for Medicare & Medicaid Services requires that all care providers who treat members in UnitedHealthcare’s Dual Special Needs Plans complete Annual Model of Care Training by Dec. 16, 2016.
The training is available in a pre-recorded training session and takes approximately 10 minutes to complete.
Go to UnitedHealthcareOnline.com > Tools & Resources > Training & Education. Scroll to the section for Medicare & Medicaid Topics and choose 2016 Special Needs Plan Model of Care Training. You will need to register to start the pre-recorded session.
To learn more about Model of Care Training, visit:
If you have questions, contact us at or
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12. Introducing: UHC On Air
Tune in to UHC On Air
On Sept. 12, 2016 we introduced UHC On Air, your source for live and on-demand video broadcasts created specifically for UnitedHealthcare care providers that features:
• National and local topics that may affect how we do business together
• New UnitedHealthcare programs and quality initiatives
• Training for our online tools
• The latest updates on operational and clinical topics
• And much more
UHC On Air gives you the opportunity to interact with our speakers and ask questions. On-demand programs are available 24 hours a day, from any device.
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13. Accessing UHC On Air
Link users can access UHC On Air by selecting the UHC On Air application tile on their Link dashboard. Please note that the application tile may be toward the bottom of your screen. After you select the application, you’ll be redirected to the UHC On Air tool. Explore the UHC News Now channel for national UnitedHealthcare information, or select your state-specific channel for local programming. To access Link, sign in to UnitedHealthcareOnline.com using your Optum ID. If you aren’t registered for UnitedHealthcareOnline.com and Link, please go to UnitedHealthcareOnline.com and select New User in the top right corner.
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14. UHC On Air Browser Requirements
You can access UHC On Air using the following Web browsers: • Internet Explorer 11 only • Firefox 45–47 • Chrome 41 • Safari 7 and above If you use a different browser, you may have problems accessing UHC On Air. For security reasons, we recommend using the newest version of Adobe Flash Player. Disable pop-up blockers and enable JavaScript.
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15. Thank you!
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