November 2019 Fall HFMA-AAHAM Payer Panel...- To sign into Link, visit UHCprovider.com and click on...

November 2019 Fall HFMA-AAHAM Payer Panel

PCA-1-19-01072_UHN-PRES_10022019 © 2019 United HealthCare Services, Inc. Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Agenda

• Updates - Community Plan - MCO - Self-Service Updates - Site of Service

• Provider Education Opportunities • Point of Care

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Updates


Community Plan - MCO

Service Model Online or Provider Service Call Center:

Link Self-Service Tools - To sign into Link, visit UHCprovider.com and click on the Link button in

the top right corner - Phone: 866-842-3278, option 1 - Email: [email protected] Provider Service Call Centers - 888-650-3462 (MCO) - 844-368-6883 (DSNP) - 877-842-3210 (Commercial, Medicare)

If your issue is still not resolved: Contact your Provider Advocate IA Provider Relations Email: [email protected]

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Presentation Notes

October Online Provider Orientation Course … This information is additional information, not in the August Network Bulletin


Self-Service

Uhcprovider.com/link, Link Enhancements Prior Authorization and Notification Tool on Link (PAAN)

In October 2019, we launched new enhanced functionality in our Prior Authorization and Notification tool on Link. This functionality was released for many service categories requiring prior authorization.

Inpatient Facilities may use this tool to: - Enter Discharge Information and Summaries - View Hospital census via reporting - Upload Clinical Information for Initial Level of Care and

Concurrent Reviews

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© 2019 UnitedHealth Group. Any use, copying or distribution without written permission from UnitedHealth Group is prohibited.

Site of Service (SOS)

Purpose Newly expanded prior authorization requirement will help to further minimize out-of-pocket costs for our plan members and improve cost efficiencies for the overall health care system while still providing access to safe, quality health care. Frequently Asked Questions https://www.uhcprovider.com/content/dam/provider/docs/public/prior-auth/Changes-Certain-Surgical-Procedures-Effective-11012019.pdf

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https://www.uhcprovider.com/content/dam/provider/docs/public/prior-auth/Changes-Certain-Surgical-Procedures-Effective-11012019.pdf














Site of Service - Scope

UnitedHealthcare commercial, including exchange, and the following benefit plans:

- UnitedHealthcare - Neighborhood Health Partnership - UnitedHealthcare of the River Valley

Applies only to:

- Planned procedures - Procedures to be performed in an outpatient hospital setting

Effective date for Iowa is March 1st, 2020

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Site of Service - Procedure Codes

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• 1,107 CPT® codes in total - 96 codes currently subject to notification / prior authorization requirements

Including 65 musculoskeletal procedure codes, which will continue to require prior authorization regardless of site of service

- 1,011 site of service only codes added to existing site of service list Will require prior authorization only if the service is to be performed in an outpatient

hospital site

CPT® Classification Count (SOS only) Musculoskeletal System 340 Digestive System 181 Eye and Ocular Adnexa 98 Integumentary System 90 Female Genital System 62 Urinary System 51 Respiratory System 50 Auditory System 38 Male Genital System 31 Cardiovascular System 28 Nervous System 28 Other 14


Site of Service - URG

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The Outpatient Surgical Procedures – Site of Service Utilization Review Guideline (URG) is updated to include all of the surgical procedures/CPT® codes in-scope

The guideline includes the criteria we’ll use to facilitate our site of service medical necessity reviews

• September 2019:

• Available in UnitedHealthcare Commercial Medical Policy Update Bulletin

• November 1, 2019:

• Available at UHCprovider.com > Policies and Protocols > Commercial Policies > Medical & Drug Policies and Coverage Determination Guidelines for UnitedHealthcare Commercial Plans

Provider Education Opportunities


November Network Bulletin

• Site of Service • Dual Special Needs 2020 expansion • Medicare Advantage 2020 expansion • BriovaRx name change to Optum • OON Lab Referral Protocol eff 11/8/19

Sign up to receive the Network Bulletin by email

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The New Provider Orientation Training Course This short, half-hour course will help you and your staff learn more about the tools and other resources you’ll need to use as you do business with UnitedHealthcare. It’s available on demand, 24/7, so you can complete it whenever your schedule allows. Click here to access the course: - chameleoncloud.io/review/2335-5c82c81c6f4b8/prod

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Presentation Notes


https://chameleoncloud.io/review/2335-5c82c81c6f4b8/prod



Check out all of the training options available at: UHCprovider.com/training We provide a full range of training resources including instructor-led sessions. Each 30- or 60-minute session concludes with a questions and answer discussion. We also have many recorded webinars to choose from.

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CEU/CME courses, free of charge From CEU/CME courses to recorded webinars, we have training options to help you stay up to date on the health care industry and learn how to use UnitedHealthcare’s many tools and resources. Highlights include:

- Evidence-Based Treatments for PTSD: An Introduction to Cognitive Processing Therapy and Prolonged Exposure Therapy

- Cancer Screening Educational Series - Advancing Health Equity

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Presentation Notes


Point of Care Assist™ Delivering enhanced benefit information at the point of care.

Proprietary information of United Health Group. Do not distributer or reproduce without written express permission of United Health Group © May 2019 UnitedHealthcare, Inc. All Rights Reserved.

Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

The solution. Point of Care Assist adds clinical, lab, claims and cost data to existing electronic medical records (EMRs)

to make it easier for providers to understand what

patients need.

Member benefit information isn’t available at the point of care.

The challenge.

Presenter

Presentation Notes

Complete member benefit information isn’t always available to providers at the point of care. That’s why at UnitedHealthcare, we’re doing all we can to simplify the health care system for. That’s why we developed Point of Care Assist, adding real-time patient information—including clinical, pharmacy, labs, prior authorization, eligibility and cost transparency— to existing electronic medical records (EMRs) to make it easier for physicians to understand what patients need.


Lab selection

Prior authorization

Referrals

Care estimator

Gaps in care

Providers need more information.

There’s an opportunity for EMRs to deliver enhanced, member-specific information when it’s needed most.

© May 2019 UnitedHealthcare, Inc. All Rights Reserved.

Presenter

Presentation Notes

There’s an opportunity for EMRs to deliver enhanced, member-specific information at the point of care. For example: It’s unclear whether prior authorization or referrals are needed. Benefit information is limited Gaps in care aren’t easily identified. There is limited visibility of a member’s network and out of pocket costs. This makes it difficult for providers to fully understand what their patients need.


Delivering more value in EMRs.

Primary care providers agree on 3 important ways EMRs can deliver more value in helping them care for patients.

Source: Stanford Medicine, Harris Poll (https://med.stanford.edu/content/dam/sm/ehr/documents/EHR-Poll-Presentation.pdf), accessed 12/18.

would like to see more interoperability

and system-wide information sharing.

67%

want integrated financial information to help patients

understand the costs of their care options.

32%

want more predictive analytics to support

diagnosis, prevention and health management.

43%

Information sharing. Cost of care. Predictive analytics.


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Presentation Notes

A 2018 study from Stanford Medicine, conducted with The Harris Poll, asked primary care physicians about their perceptions of EMR systems and the improvements they would most like to see in the next decade. 67 percent of primary care physicians agreeing they’d like to see more interoperability of EMRs and more system-wide information sharing. In addition, 32 percent agreed they want access to more integrated financial information to help their patients understand the costs of care so they can choose lower-cost options. And 43 percent said they want more data to support disease diagnosis, prevention and health management.

PCA-1-19-01072_UHN-PRES_10022019 © 2019 United HealthCare Services, Inc. PCA-1-19-01072_UHN-PRES_10022019 © 2019 United HealthCare Services, Inc. Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

We provide more insight.

Point of Care Assist integrates patient health records with EMRs for key insights on patient needs at the point of care.

Lab selection

Prior authorization

Referrals

Care estimator

Gaps in care


Presenter

Presentation Notes

Point of Care Assist integrates patients’ UnitedHealthcare health records with EMRs to provide real-time insights on care needs—aligned to their specific member benefits and costs. It also provides insights into high quality cost effective providers identified through the UnitedHealth Premium® Provider program. This program provides physician designations based on quality and cost efficiency criteria to help members make more informed choices for their medical care. This helps improve providers’ workflow process, allowing them to quickly and easily check: Prior authorization, including: Eligibility Benefit coverage And other requirements Referral requirements Care estimator Information needed for lab selection Potential gaps in care, such as missed screenings or unfilled prescriptions By adding Point of Care Assist to existing EMRs, providers have the information they need to better serve patients and achieve better results for their practice.

Get insights on patient needs.

Save time and money.

Improve patient satisfaction and results.


Presenter

Presentation Notes

At UnitedHealthcare, we’re doing all we can to simplify the health care system for everyone—including providers. We believe the more providers know, the more effective they can be. That’s why we developed Point of Care Assist , to make it easier for providers to: Understand what patients need at the point of care. Save time and money. And improve patient satisfaction and results.


Get insights on patient needs.

Get insights on patient care needs, costs and coverage at the point of care.

Select labs based on impact to the member.

Get automated alerts to help identify gaps in care.


Presenter

Presentation Notes

Point of Care Assist integrates patients’ UnitedHealthcare health records with your EMRs to give providers real-time patient insights at the point of care, including costs, coverage and member-centric lab options. We help providers quickly identify gaps in care, with personalized notifications and alerts to help them better serve patients.


Save time and money.

Access coverage information within EMRs to confirm eligibility and see if prior authorizations or referrals are needed.

Access cost information to help patients find lower-cost care care options that are in the network.

Locate UnitedHealth Premium® Program providers known for delivering quality, cost-effective care.


Presenter

Presentation Notes

Point of Care Assist helps save time and money by making it easier to: Check coverage information—including prior authorization and referral requirements—and confirm eligibility; Check cost information to help patients choose lower-cost care options that are in the network and find UnitedHealth Premium® Program providers known for quality, cost-efficient care; And get access to real-time, accurate information to reduce administrative burden and re-work.


Improve satisfaction and results.

Simplify care.

Improve quality.

Increase cost transparency.

Earn higher Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores.

Improve Medicare Star Ratings.

Improve ability to earn incentives by closing gaps in care.

Higher-quality care | Lower costs | A better health care experience


Presenter

Presentation Notes

These insights help providers improve patient satisfaction and results by simplifying care and increasing cost transparency. For example: Giving providers the information they need to help improve the quality of care, which may lead to higher Consumer Assessment of Health Providers and Systems (CAHPS) scores and Medicare Star Ratings. And improving their ability to earn incentives through the Medicare Advantage Primary Care Physician Incentive (MA-PCPi) program. Our goal is to support the triple aim: higher quality care, lower costs and a better health care experience for the people we serve.


Here’s how it works.

Real-time members’ health data is added to

existing EMRs for UnitedHealthcare

members.

Information is delivered as part of providers’ current

workflow process to ease administration and reduce re-work.

Automatically alerts providers to

patient care needs, aligned to member-

specific benefits.

Information is updated in real time and available 24/7.


Presenter

Presentation Notes

Point of Care Assist integrates patients’ UnitedHealthcare health records with EMRs as part of providers’ current workflow process to help ease the administrative burden and reduces re-work for providers. Providers automatically receive a real-time view, alerts and insights on patient care needs aligned to their UnitedHealthcare member benefits. Information is available when you need it, available in real time, 24/7. And all information is accurate and updated in real time—24 hours a day, 7 days a week—which means providers know they’re getting the very latest information they need to deliver the best possible care to their patients.


At check-in.

Important information is available the moment a patient checks in.


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Presentation Notes

Updated information is refreshed when the patient checks in, based on current member benefits since their appointment was scheduled—including their deductible, insurability and any possible gaps in care.


During the patient visit.

Alerts and notifications appear as patient information is accessed.


Presenter

Presentation Notes

This allows you to compare multiple member-centric options and gain additional insights based on the member’s specific benefit information. You’ll be able to leverage the information in your treatment to use relevant information for shared decision making. This makes it possible for providers to talk with patients about treatment options and locations, taking costs and quality into consideration. And to be able to explore network care options to improve transparency.


Exploring care options and costs.

Cost information is available at the point of care to help patients find lower-cost care options—improving price transparency.


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