2021 Virginia Community Plan Provider Manual
2021Virginia CommunityPlan Provider ManualPhysician, Health Care Professional, Facility and AncillaryIncludes: Commonwealth Coordinated Care Plus, Medicaidand Family Access to Medical Insurance Security Community PlansDoc#: PCA-1-016644-05172021 05282021v56.2.2021
WelcomeWelcome to the CCC Plus,Medicaid and FamilyAccess to Medical InsuranceSecurity (FAMIS) ProviderManualThis up-to-date Commonwealth Coordinated Care Plus(CCC Plus) and Medallion 4.0 reference PDF manualallows you and your staff to find important informationsuch as how to process a claim and prior authorization.This manual also includes important phone numbersand websites on the How to Contact Us page. Findoperational policy changes and other electronic tools onour website at UHCprovider.com.Click the following links to access differentmanuals: UnitedHealthcare Administrative Guide forCommercial and Medicare Advantage memberinformation. Some states may also have MedicareAdvantage information in their Community Planmanual. A different Community Plan manual: go toUHCprovider.com/guides. Select Community PlanCare Provider Manuals, select state.Easily find information in this manual usingthe following steps:1. Select CTRL F.2. Type in the key word.3. Press Enter.If available, use the binoculars icon on the top right handside of the PDF to search for information and topics. Wegreatly appreciate your participation in our program andthe care you offer our members.If you have questions about the informationor material in this manual, or about ourpolicies, please call Provider Services.Important informationabout the use of this manualIf there is a conflict between your Agreement and thiscare provider manual, use this manual unless yourAgreement states you should use it, instead. If there isa conflict between your Agreement, this manual andapplicable federal and state statutes and regulationsand/or state contracts, applicable federal and statestatutes and regulations and/or state contracts willcontrol. UnitedHealthcare Community Plan reservesthe right to supplement this manual to help ensure itsterms and conditions remain in compliance with relevantfederal and state statutes and regulations.This manual will be amended as policies change.Terms and definitions as used in this manual: “Member” or “customer” refers to a person eligibleand enrolled to receive coverage from a payer forcovered services as defined or referenced in yourAgreement. “You,” “your” or “provider” refers to any healthcare provider subject to this manual, includingphysicians, health care professionals, facilities andancillary providers; except when indicated andall items are applicable to all types of health careproviders subject to this guide. “Community Plan” refers to UnitedHealthcare’sMedicaid plan “Your Agreement,” “Provider Agreement” or“Agreement” refers to your Participation Agreementwith us. “Us,” “we” or “our” refers to UnitedHealthcareCommunity Plan on behalf of itself and its otheraffiliates for those products and services subject tothis guide. Any reference to “ID card” includes both a physicalor digital card.2 UnitedHealthcare Community Plan of Virginia v 56.2.2021 2021 UnitedHealthcare
Table of Contents4Chapter 1: IntroductionChapter 2: Care Provider Standards and Policies19Chapter 3: Care Provider Office Procedures and Member Benefits28Chapter 4: Medical Management32Chapter 5: Early, Periodic Screening, Diagnosis and Treatment (EPSDT)/Prevention49Chapter 6: Value-Added Services52Chapter 7: Mental Health and Substance Use56Chapter 8: Member Rights and Responsibilities61Chapter 9: Medical Records64Chapter 10: Quality Management (QM) Program and Compliance Information68Chapter 11: Billing and Submission75Chapter 12: Claim Reconsideration, Appeals and Grievances82Chapter 13: Care Provider Communications and Outreach92Glossary94Appendix983 UnitedHealthcare Community Plan of Virginia v 56.2.2021 2021 UnitedHealthcare
Chapter 1: IntroductionKey contactsTopicProvider /trainingProvider Portal Supportemail: ProviderTechSupport@uhc.comOnline Service ToolsResource LibraryCommunityCare Provider PortalUHCprovider.com Menu Resource Library Online Service ToolsUHCprovider.com Menu Resource LibraryPhone NumberCCC Plus: 877-843-4366Medallion: 844-284-0146CCC Plus: 877-843-4366Medallion: 844-284-0146855-819-5909866-842-3278, option 1Looking for something else? In PDF view, click CTRL F, then type the keyword. In web view, type your keyword in the “what can we help you find?” search bar.UnitedHealthcare Community Plan of Virginia providesbenefits to: COMMUNITY PLAN COMMONWEALTHCOORDINATED CARE PLUS PLAN (CCC Plus)members, which include ABD- Aged, Blind, andDisabled Medallion 4.0 members, serving Medicaid andFAMIS - Family Access to Medical InsuranceSecurity which include:- LIFC: Low Income Families with ChildrenHow to join our networkFor instructions on joining theUnitedHealthcare Community Planprovider network, go to UHCprovider.com/join. There you will find guidance onour credentialing process, how to sign upfor self-service tools and other helpfulinformation.- CHIP: Children’s Health Insurance ProgramIf you have questions about the information in thismanual or about our policies, go to UHCprovider.comor call Provider Services at:877-843-4366 – CCC Plus ProviderServices844-284-0146 – Medallion ProviderServices4 UnitedHealthcare Community Plan of Virginia v 56.2.2021 Already in network and need to make achange?To change an address, phone number, add or removephysicians from your TIN, or other changes, go toMy Practice Profile at UHCprovider.com Menu Demographics and Profiles. 2021 UnitedHealthcare
Chapter 1: IntroductionCCC Plus overviewWhat is UnitedHealthcare Community PlanCommonwealth Coordinated Care Plus andMedallion 4.0 plan?Managed care is when health care organizationsmanage how members receive health care services.Managed Care Organizations (MCOs) work with differentcare providers to offer quality health care services.The goals of UnitedHealthcare Community Plan CCCPlus plan are to provide: Coordinated long-term care across different healthcare settings A choice of the best long-term care plan for theirneeds Long-term care plans with the ability to offer moreservices Access to cost-effective community-based long-termcare servicesMembers in CCC Plus plan have their services/caremanaged through the Managed Care Health Plan. Wework with you to offer quality health care services and tohelp ensure members have access to covered services.The CCC Plus plan’s goals are to provide coordinatedlong term care services across different health caresettings and to provide access to cost- effectivecommunity-based long-term care services.Enrollment in the CCC Plus plan will not change amember’s Medicare benefits.These benefits allow at-risk individuals to remain athome and improve their quality of life.How the CCC Plus plan worksWe have a contract with the Commonwealth of Virginia’sDepartment of Medical Assistance Services (DMAS).We support and coordinate all CCC Plus-coveredbenefits for members. It helps members remain inthe community. The managed care plan also helps toprovide the member with every opportunity to improvequality of life and, when or if possible, allow for asuccessful transition back into the community from afacility.5 UnitedHealthcare Community Plan of Virginia v 56.2.2021 The plan uses covered benefits, enhanced benefits,community resources, caregiver/family supportsystems and primary care providers (PCPs) to meet themember’s overall care needs. We are required to complywith any new Medicaid coverage decisions.CCC Plus plan care provider relationshipThe success of our plan depends on strong relationshipswith you. Each member has an assigned care manager,and we encourage members to work with their caremanager to coordinate care and help them accesscovered benefits. If the member uses a non-contractedcare provider, the services are not covered unlessauthorized by the care manager.The member and UnitedHealthcareCommunity PlanOnly CCC Plus plan members who meet eligibilityrequirements and are living in a region with authorizedManaged Care Plans are eligible to be in the CCC PlusPlan. Each member has a choice of Managed CarePlans. They may select any authorized Managed CarePlan unless the Managed Care Plan is restricted to aspecific population that does not include the member.The Department of Medical Assistance Services, or itsagent, is responsible for enrollment, including enrollmentinto the CCC Plus Plan, disenrollment and outreach andeducation.We accept Medicaid recipients without restriction in theorder they enroll. We do not discriminate on the basis ofreligion, gender, race, color, age or national origin, healthstatus, pre-existing condition or need for health careservices.Care coordinator provisionsEach member has an assigned care manager. They workwith the care providers, and authorized representatives,to develop and coordinate the care plan. A Medicarebeneficiary can access any Medicare-approved careprovider without authorization. 2021 UnitedHealthcare
Chapter 1: IntroductionMedallion overviewThe Medallion 4.0 plan serves Medicaid & FAMISmembers throughout Virginia. The program goals areto increase member and provider engagement, supportintegration and innovation, and improve healthcarequality and outcomes.Who is eligible?Medallion 4.0 adds new populations and services: Pregnant women Infants Children/teens Children in foster care or adoption assistance Early intervention services Mental Health Services (MHS) Third-party liability Adults between 19 and 64 years old.Go to coverva.org for more information on eligiblepopulations.Medallion 4.0 covered benefits for eligible individualsinclude comprehensive health care and preventionservices including: Prenatal, delivery and postpartum care Newborn, pediatric (through age 19), preventive andacute treatment, including immunizations, healthscreening and Early, Periodic Screening Diagnosticand Treatment (EPSDT) through age 21 Foster Care and Adoption Assistance Addiction and Recovery Treatment Services (ARTS) Telemedicine Care Management Mental Health and Rehabilitation ServicesVirginia Medicaid expansionOn Jan. 1, 2019, Virginia expanded Medicaid eligibilityguidelines. These eligibility guidelines apply to Virginiaresidents age 19-64. Members receive services throughMedallion 4.0 (excluding FAMIS) and CCC Plus healthplans. Coverage includes all Medicaid covered services.Find more information at coverva.org.6 UnitedHealthcare Community Plan of Virginia v 56.2.2021 Our approach to health careWhole Person Care modelThe Whole Person Care (WPC) program seeks toempower UnitedHealthcare Community Plan membersenrolled in Medicaid, care providers and our communityto improve care coordination and elevate outcomes.Targeting UnitedHealthcare Community Plan memberswith chronic complex conditions who often use healthcare, the program helps address their needs holistically.WPC examines medical, behavioral and social/environmental concerns to help members get the rightcare from the right care provider in the right place and atthe right time.The program provides interventions to memberswith complex medical, behavioral, social, pharmacyand specialty needs, resulting in better quality of life,improved access to health care and reduced expenses.WPC provides a care management/coordinationteam that helps increase member engagement, offersresources to fill gaps in care and develops personalizedhealth goals using evidence-based clinical guidelines.This approach is essential to improving the health andwell-being of the individuals, families and communitiesUnitedHealthcareCommunity Plan serves. WPC provides: Market-specific care management encompassingmedical, behavioral and social care. An extended care team including primary careprovider (PCP), pharmacist, medical and behavioraldirector, and peer specialist. Options that engage members, connecting them toneeded resources, care and services. Individualized and multidisciplinary care plans. Help scheduling and coordinating appointmentswith PCP and other appointments. The WPCProgram refers members to an RN, behavioralhealth advocate or other specialists as required forcomplex needs. Education and support with complex conditions. Tools for helping members engage with providers,such as appointment reminders and help withtransportation. Foundation to build trust and relationships with hardto-engage members. 2021 UnitedHealthcare
Chapter 1: IntroductionThe goals of the WPC program are to: Lower avoidable admissions and unnecessaryemergency room (ER) visits, measured outcomes byinpatient (IP) admission and ER rates. Improve access to PCP and other needed services,measured by number of PCP visit rates withinidentified time frames. Identify and discuss behavioral health needs,measured by number of behavioral health careprovider visits within identified time frames. Improve access to pharmacy. Identify and remove social and environmentalbarriers to care. Improve health outcomes, measured by improvedHealth Plan Employer Data and Information Set(HEDIS ) and Centers for Medicare & MedicaidServices (CMS) Star Ratings metrics.Program. Linguistic and cultural barriers can negativelyaffect access to health care participation. You mustsupport UnitedHealthcare Community Plan’s CulturalCompetency Program.UnitedHealthcare Community Plan offers the followingsupport services: Language Interpretation Line: If members donot speak English and need to call us or go to adoctor’s appointment, the member’s care/servicecoordinator orders an interpreter by calling ProviderServices. Materials for limited English speaking members:We provide simplified materials for memberswith limited English proficiency and who speaklanguages other than English or Spanish. We alsoprovide materials for visually impaired members. Empower the member to manage their complex/chronic illness or problem and care transitions.Enrollment broker Improve coordination of care through dedicated staffresources and to meet unique needs.DMAS contracts with an enrollment broker to helpmembers with enrollment using a toll free memberservice helpline and website. Members may call CoverVirginia at 855-242-8282 Monday through Friday from8 a.m. to 7 p.m. and Saturday 9 a.m. to 12 p.m. EasternTime or go to the Cover Virginia website atcoverva.org to apply or make changes to Medicaidenrollment. If members do not have coverage, they clickon “Apply”. If they want to make a change, they select“Already Enrolled”. Engage community care and care provider networksto help ensure access to affordable care and theappropriate use of services.Referring your patientTo refer your patient who is a UnitedHealthcareCommunity Plan member to WPC, call Provider Servicesat: 877-843-4366 – CCC Plus Provider Services 844-284-0146 – Medallion Provider ServicesComplianceHIPAA mandates National Provider Identifier (NPI)usage in all standard transactions (claims, eligibility,remittance advice, claims status request/response,and authorization request/response) for all health careproviders who handle business electronically.Cultural competencyresourcesTo help you meet membership needs, UnitedHealthcareCommunity Plan has developed a Cultural Competency7 UnitedHealthcare Community Plan of Virginia v 56.2.2021 An enrollment broker is an independent broker (thirdparty vendor) who enrolls members in the healthplan and who is responsible for the operation anddocumentation of a toll-free member service helpline.The responsibilities of the enrollment broker include, butare not limited to, member education and enrollment,assistance with and tracking of member’s grievanceresolution, and may include member marketing andoutreach.Evidence-based clinicalreview criteria andguidelinesUnitedHealthcare Community Plan uses InterQual CareGuidelines (formerly MCG Care Guidelines) for medicalcare determinations. 2021 UnitedHealthcare
Chapter 1: IntroductionOnline resourcesUHCprovider.com is your home for care providerinformation with access to Electronic Data Interchange(EDI), Provider Portal online tools, medical policies, newsbulletins, and great resources to support administrativetasks including eligibility, claims, claims status and priorauthorizations and notifications. Go to Self Service forSelf Service Tool online training and information.Electronic Data Interchange (EDI)EDI is an online resource using your internal practicemanagement or hospital information system to exchangetransactions with us through a clearinghouse.The benefit of using EDI is it permits care providersto send batch transactions for multiple members andmultiple payers in lieu of logging into different payerwebsites to manually request information. This is whyEDI is usually care providers’ first choice for electronictransactions. Send and receive information faster Identify submission errors immediately and avoidprocessing delays Exchange information with multiple payers Reduce paper, postal costs and mail time Cut administrative expenses EDI transactions available to care providers are:- Claims (837),- Eligibility and benefits (270/271),- Claims status (276/277),- Referrals and authorizations (278),- Hospital admission notifications (278N), and- Electronic remittance advice (ERA/835).Visit UHCprovider.com/EDI for more information. Learnhow to optimize your use of EDI at UHCprovider.com/optimizeEDI.Getting started If you have a practice management or hospitalinformation system, contact your software vendor forinstructions on how to use EDI in your system. Contact clearinghouses to review which electronictransactions can interact with your software system. Read our Clearinghouse Options page for moreinformation.8 UnitedHealthcare Community Plan of Virginia v 56.2.2021 Provider Portal – secure care providerwebsiteProvider Portal provides a secure online portal tosupport your administrative tasks including eligibility,claims and prior authorization and notifications.To sign in to the Provider Portal, go to UHCprovider.comand click the Sign In button in the upper right corner. Formore information about all Provider Portal tools, go toUHCprovider.com, then click Sign In. o access the Provider Portal, the secureTcare provider website, go to UHCprovider.com and either sign in or create a user ID.You will receive your user ID and passwordwithin 48 hours.The secure care provider website lets you: Verify member eligibility including secondarycoverage. Review benefits and coverage limits. Check prior authorization status. Access remittance advice and review recoveries. Review your preventive health measure report. Access the Early and Periodic Screening, Diagnosis,and Treatment (EPSDT) toolset. Search for CPT codes. Type the CPT code inthe header search box titled “what can we helpyou find?” on UHCprovider.com, and the searchresults will display all documents and/or web pagescontaining that code. Find certain web pages more quickly usingdirect URLs. You’ll see changes in the way wedirect you to specific web pages on ourUHCprovider.com provider portal. You can nowuse certain direct URLs, which helps you find andremember specific web pages easily and quickly.You can access our most used and popular webpages on UHCprovider.com by typing in that page’sdirect URL identified by a forward slash in the webaddress, e.g., UHCprovider.com/claims. Whenyou see that forward slash in our web links, you cancopy the direct URL into your web page address barto quickly access that page.You will conduct business with us electronically. Usingelectronic transactions is fast, efficient, and supportsa paperless work environment. Use both EDI and 2021 UnitedHealthcare
Chapter 1: IntroductionUnitedHealthcare Provider Portal for maximum efficiencyin conducting business electronically. To access theProvider Portal, go to uhcprovider.com, then Sign In.Here are the most frequently used tools on the ProviderPortal: Eligibility and Benefits — View patient eligibility andbenefits information for most benefit plans. For moreinformation, go to UHCprovider.com/eligibility. Claims — Get claims information for manyUnitedHealthcare plans, including access letters,remittance advice documents and reimbursementpolicies. For more information, go to UHCprovider.com/claims.5reasonsto useUHCprovider.com1Provider PortalClick “Sign In” in the top rightcorner of UHCprovider.com Prior Authorization and Notification — Submitnotification and prior authorization requests. Formore information, go to UHCprovider.com/paan. Specialty Pharmacy Transactions — Submitnotification and prior authorization requests forcertain medical injectable specialty drugs. Go toUHCprovider.com/pharmacy for more information. My Practice Profile — View and update yourprovider demographic data that UnitedHealthcaremembers see for your practice. For moreinformation, go to UHCprovider.com/mypracticeprofile. Document Vault — Access reports and claim lettersfor viewing, printing, or download. The DocumentVault Roster provides member contact informationin a PDF and can only be pulled at the individualpractitioner level. For more information, go toUHCprovider.com/documentvault. Paperless Delivery Options — The PaperlessDelivery Options tool can send daily or weekly emailnotifications to alert you to new letters when weadd them to your Document Vault. With our deliveryoptions, you decide when and where the emailsare sent for each type of letter. This is available toProvider Portal One Healthcare ID password ownersonly.Watch for the most current information on our selfservice resources by email, in the Network Bulletin, oronline at UHCprovider.com/EDI or the Provider Portal atUHCprovider.com then click Sign In.For more instructions, visit UHCprovider.com/Trainingor Self Service Tools for online training and information.9 UnitedHealthcare Community Plan of Virginia v 56.2.2021 PriorAuthorizationand Notification23Request approval forprescriptions, admissionsand procedures.UHCprovider.com/paanSend batch transactionsfor multiple members andpayers from one place,review claims and onnect5Policiesand ProtocolsUse self-service to verifyeligibility and claims, requestprior authorization, providenotifications and accessDocument Vault.Communicate securelywith payers to addresserrant claims. Emaildirectconnectsupport@optum.com to get started.Review guidelines thatapply to UnitedHealthcareCommunity Plan andhow you care for ourmembers.UHCprovider.com/policiesFind more information about these online services and moreat UHCprovider.com – your hub for online transactions,education and member benefit information. 2021 UnitedHealthcare
Chapter 1: IntroductionDirect ConnectProvider ServicesDirect Connect is a free online portal that lets yousecurely communicate with payers to address errantclaims. This portal has the ability to replace previousmethods of letters, phone calls and spreadsheets. It alsohelps:Provider Services is the primary contact for careproviders who require assistance. It is staffed withrepresentatives trained specifically for UnitedHealthcareCommunity Plan. Manage overpayments in a controlled process. Create a transparent view between care providerand payer. Avoid duplicate recoupment and returned checks. Decrease resolution timeframes. Real-time reporting to track statuses of inventories inresolution process. Provide control over financial resolution methods.Provider Services can assist you withquestions on Medicaid benefits, eligibility,claim decision, forms required to reportspecific services, billing questions andmore.Provider Services works closely with all departments inUnitedHealthcare Community Plan.All users will access Direct Connect using the ProviderPortal. On-site and online training is available.Email directconnectsupport@optum.comto get started with Direct Connect.PrivilegesTo help our members access appropriate care andminimize out-of-pocket costs, you must have privilegesat applicable in-network facilities or arrangements withan in-network provider to admit and provide facilityservices. This includes full admitting hospital privileges,ambulatory surgery center privileges and/or dialysiscenter privileges.10 UnitedHealthcare Community Plan of Virginia v 56.2.2021 2021 UnitedHealthcare
Chapter 1: IntroductionHow to contact us*We no longer use fax numbers for most departments, including benefits, prior authorization and claims.Medicaid/FAMISPhoneTopicWebsite/AddressCCC 366 844-284-0146 Confirm a member’s benefitsand/or prior authorization.Cardiology gy866-889-8054 866-889-8054 Phone line is available from 7a.m. to 7 p.m., Eastern Time(ET), Monday through Friday.Prior authorization numbersrepresent the specific procedurerequested and are valid for 45calendardays from the date they areissued.Chiropractor Caremyoptumhealthphysicalhealth.comNot acoveredbenefit.ClaimsUse the Provider Portal atUHCprovider.com/claims877-843-4366 844-284-0146 Verify a claim status or getinformation about propercompletion or submission ofclaims.Mailing address:UnitedHealthcareCommunity PlanP.O. Box 5270Kingston, NY 12402Information844-284-0146 We provide members olderthan 21 with up to six visits percalendar year with an in-networkchiropractor. This benefit doesnot need prior authorization.For FedEx (use for largepackages/more than 500pages):UnitedHealthcareCommunity Plan1355 S 4700 West,Suite 100Salt Lake City, UT 8410411 UnitedHealthcare Community Plan of Virginia v 56.2.2021 2021 UnitedHealthcare
Chapter 1: ee the Overpaymentsection for requirementsbefore sending yourrequest.Sign in to UHCprovider.com/claims to access theProvider Portal, then selectthe UnitedHealthcareOnline appCCC 6 844-284-0146 Ask about claim overpayments.Mailing address:UnitedHealthcareCommunity PlanATTN: Recovery ServicesP.O. Box 740804Atlanta, GA 30374-0800"Dental nic DataIntake Claim Issuesac edi ops@uhc.comElectronic DataIntake Log-onIssuesEligibilityEnterprise VoicePortal888-912-3456 888-912-3456 Dental services are providedby Smiles for Children andDentaQuest. Available Mondaythrough Friday, 8 a.m. to 6 p.m.,ET.800-210-8315 800-210-8315 Ask about claims issues orquestions.800-842-1109 800-842-1109 Information is also available atUHCprovider.com.To access eligibilityinformation, go toUHCprovider.comthen Sign In to theProvider Portal or goto UHCprovider.com/eligibility.877-843-4366 844-284-0146 Confirm member eligibility.877-842-3210 877-842-3210 The Enterprise VoicePortal provides self-servicefunctionality or call steering priorto speaking witha contact center agent.12 UnitedHealthcare Community Plan of Virginia v 56.2.2021 2021 UnitedHealthcare
Chapter 1: IntroductionTopicWebsite/AddressEthics andCompliance HelpCenterFraud and Abuse(Payment Integrity)CCC 1 800-455-4521 Report unethical, unlawful orinappropriate behavior by aUnitedHealthcare CommunityPlanemployee.MFCU mail@oag.state.va.usPayment an Integrity of Claim,Reports, andRepresentations to theGovernment800-455-4521 800-455-4521 Learn more about our paymentororintegrity policies. Notify us800-286-3932 800-286-3932 anonymously of suspectedfraud or abuse on the part of aprovider or member. TheMedicaid Fraud and AbuseComplaint Form is availableonline at: oag.state.va.us Programs & Initiatives Medicaid FraudReporting:uhc.com/fraudLaboratory Services UHCprovider.com Find Dr 888-522-2677 888-522-2677 LabCorp and Quest are the Preferred Lab Network866-697-8378 866-697-8378 preferred lab providers.Medicaiddmas.virginia.gov855-242-8282 855-242-8282 Contact VA Medicaid directly.13 UnitedHealthcare Community Plan of Virginia v 56.2.2021 2021 UnitedHealthcare
Chapter 1: IntroductionCCC formationMedical ClaimDisputesSign in to the Provider877-236-0826 844-752-9434 Claim issues includePortal at UHCprovider.overpayment, underpayment,com or go to UHCprovider.payment denial, or an original orcom/claims for morecorrected claim determinationinformation.you don’t agree with.Reconsiderations mailingaddress:UnitedHealthcareCommunity PlanP.O. Box 5270Kingston, NY 12402Appeals mailing address:Community PlanGrievancesand AppealsP.O. Box 31364Salt Lake City, UT 841310364In-Person Delivery Address:9020 Stony Point Parkway,Suite 400Richmond, VA 23235Member Servicesmyuhc.com866-622-7982 844-752-9434 Assist members with issues orconcerns. Available 8 a.m. –8 p.m. ET, Monday throughFriday.Mental Healthproviderexpress.com& SubstanceAbuse (includingCommunityMental HealthRehabilitationServices &Addiction RecoveryTreatment Services)877-843-4366 844-284-0146Multilingual/TelecommunicationDevice for the Deaf(TDD) ServicesTDD 711National Planand ProviderEnumerationSystem (NPPES)nppes.cms.hhs.govTDD 711Available 8 a.m. – 5 p.m.Central Time, Monday throughFriday, except state-designatedholidays.800-465-3203 800-465-3203 Apply for a National ProviderIdentifier (NPI).14 UnitedHealthcare Community Plan of Virginia v 56.2.2021 2021 UnitedHealthcare
Chapter 1: esource Team(NMRT)networkhelp@uhc.comNurseLineObstetrics andBaby CareCCC 0 877-842-3210 Self-service functionality toupdate or check credentialinginformation.800-842-3014 800-842-3014 Available at any time.Pregnancy Notification800-599-5985 800-599-5985
Commonwealth Coordinated Care Plus and Medallion 4.0 plan? Managed care is when health care organizations manage how members receive health care services. Managed Care Organizations (MCOs) work with different care providers to offer quality health care services. The goals of Unit
Provider Transition Plan (PTP) System PTP #AD-003910 Provider Information * Mandatory (required) fields below are marked with an asterisk. Legacy Provider ID * 0 New Provider ID * 0 Provider Name * Demonstration Provider Provide
August 2, 2021 15 August 2, 2021 16 August 2, 2021 17 August 3, 2021 18 August 4, 2021 19 August 5, 2021 20 August 6, 2021 21 August 9, 2021 22 August 9, 2021 23 August 9, 2021 24 August 10, 2021 25 August 11, 2021 26 August 12, 2021 27 August 13, 2021 28 August 16, 2021 29 August 16, 2021 30 August 16, 2021 31
Medicine provider, but they had insufficient data (i.e., the provider group does not have enough commercial health plan claims data to be evaluated, as required by the statistical requirements of the Provider Excellence Program; the provider group did not have enough quality data; or the provider group does not have enough cost-efficiency data). 3.
Virginia Agriculture in the Classroom Virginia Association of Science Teachers Virginia Junior Academy of Science Virginia Master Naturalist Program (Virginia Cooperative Extension/Virginia Tech) WHRO Public Media Vernier Software & Technology Virginia Transportation
Native Shrubs and Woody Vines of Virginia Virginia Department of Forestry Identification Guide www.dof.virginia.gov This institution is an equal opportunity provider. Virginia Department of Forestry 900 Natural Resources Drive, Suite 800 Charlottesville, Virginia 22903 Phone: (434) 977-6555
Provider ID: 1457472029 Provider Gender: Male Accepting New Patients: Yes Anthony Euser, DO 2801 Purcell St Brighton, CO 80601 303-659-7600 Adams County Provider ID: 1588634810 Provider Gender: Male Accepting New Patients: Yes John Fontenot, MD 1860 E Egbert St Brighton, CO 80601 303-659-4000 Adams County Provider ID: 1033373410 Provider Gender .
you might receive a bill from a provider for the difference between the provider's charge and what your plan pays (balance billing). Be aware, your network provider might use an out-of-network provider for some services (such as lab work). Check with your provider before you get services. Template 1 of 8. plan. plan. plan. premium. www.kp.org .
Provider Directory Validation Ensure provider directory contains accurate information for members Baseline Study: 80% for initial provider accuracy rate Subsequent Studies: 95% accuracy rate Phase 1: Provider Access Study The four activities included in Phase 1 are described in Figure 1: Phase 1—Provider Access Studies.
