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How to Contact All Savers - All Savers Supplement, 2018 UnitedHealthcare Administrative Guide

How to Contact All Savers

Group Number 908867 and 908868

Resource:

Cardiology
Diagnostic Catheterization, Electrophysiology Implants, Echocardiogram and Stress Echocardiogram

Where to go:

Online: UHCprovider.com/cardiology; select the Go to Prior Authorization and Notification App.
Phone: 866-889-8054

Requirements and Notes:

Request prior authorization for services as described in the Outpatient Cardiology Notification/ Prior Authorization Protocol section of Chapter 6: Medical Management

Resource:

Chemotherapy (outpatient injectable)

Where to go:

Online: UHCprovider.com > Notifications/Prior Authorizations
Phone: 866-889-8054

 

Resource:

Claims Submission

Where to go:

Electronic Claims Submission: Payer ID 81400
Paper Claims Submission: Mail to the address listed on the back of the ID Card.

Resource:

Pharmacy Services

Where to go:

Prior Authorizations Phone: 800-711-4555
Fax for Non-specialty Meds: 800-527-0531
Fax for Specialty Meds: 800-853-3844
Benefit Information: Call the number on the back of the ID Card.

Requirements and Notes:

For information on the Prescription Drug List (PDL), myallsavers.com

Resource:

Prior Authorization and Notification

Where to go:

Online: UHCprovider.com/priorauth
Phone: 800-999-3404

Requirements and Notes:

Prior authorization and admission notification is required as described in Chapter 6: Medical Management. EDI 278A transactions are not available.

Resource:

Radiology/Advanced Outpatient Imaging Procedures: CT scans, MRIs, MRAs, PET scans and nuclear medicine studies, including nuclear cardiology

Where to go:

Online: UHCprovider.com/radiology; select the Go to Prior Authorization and Notification App.
Phone: 866-889-8054

Requirements and Notes:

Request prior authorization for services as described in the Outpatient Radiology Notification/Prior Authorization Protocol section of Chapter 6: Medical Management

Health Care ID Card

ASIC members receive health care ID cards with formation that helps you to submit claims. The cards list the claims address, copayment information, and phone numbers.

Check the member’s health care ID card at each visit. Copy both sides for your files. Use ASIC electronic payer ID 81400 to file claims.

A sample health care ID card and more information is in the Health Care Identification (ID) Cards section in Chapter 2.

Our Claims Process

Follow these steps for fast payment:

  1. Notify ASIC.
  2. Prepare a complete and accurate claim form.
  3. For ASIC members - submit electronic claims using Payer ID number 81400. Submit paper claims to the address on the member’s health care ID card.
  4. For contracted care providers who submit electronic claims and would like to receive electronic payments and statements, call Optum Financial Services Customer Service line at 877-620-6194 or visit OptumHealthFinancial.com > Physicians & Health Care Providers > Electronic Payments and Statements.

Claim Reimbursement (Adjustments)

If you think your claim was processed wrong, call the number on the member’s health care ID card. If you find a claim where you were overpaid, send us the overpayment within 30 calendar days. If we find a claim that was overpaid, payment is due within 30 calendar days.

If you disagree with our decision regarding a claim adjustment, you can appeal.

Claim Reconsideration, Appeals and Disputes

Claim reconsideration does not apply to some states based on applicable state legislation (e.g. Arizona, California, Colorado, New Jersey or Texas). For states with applicable legislation, any request for dispute will follow the state specific process.

There is a two-step process available for review of your concern. Step one is a Claim Reconsideration. If you disagree with the outcome of the Claim Reconsideration, you may request a Claim Appeal (step two).


How to Submit your Reconsideration or Appeal

If you disagree with claim payment issues, overpayment recoveries, pharmacy, medical management disputes, contractual issues or the outcome of your reconsideration review, send a letter requesting a review to:

ASIC Members:
Grievance Administrator
P.O. Box 31371
Salt Lake City, UT 84131-0371
Standard Fax: 801-478-5463
Phone: 800-291-2634

If you feel the situation is urgent, request an expedited
appeal by phone, fax, or writing:

Grievance Administrator
3100 AMS Blvd.
Green Bay, WI 54313
Expedited Fax: 866-654-6323
Phone: 800-291-2634

Timeframe
You must submit your claim reconsideration and/or appeal to us within 12 months (or as required by law or your participation agreement), from the date of the original EOB or denial. The two-step process allows for a total of 12 months for timely submission, not 12 months for step one and 12 months for step two.

What to Submit
As the care provider of service, you should submit the dispute with the following information:

  • Member’s name and health care ID number
  • Claim number
  • Specific item in dispute
  • Clear rationale/reason for contesting the determination and an explanation why the claim should be paid or approved

If you disagree with the outcome of the claim appeal, you may file for an arbitration proceeding. You can find a description of this process in your participation agreement. Refer to Claim Reconsideration, Appeals Process and Resolving Disputes section in Chapter 9: Our Claims Process, for more information.

Notice to Texas Care Providers

To verify ASIC members’ benefits, call the number on the back of the member’s health care ID card. ASIC use tools developed by third parties, such as MCG (formerly Milliman Care Guidelines), to help manage health benefits and to assist clinicians make informed decisions.

As an affiliate of UnitedHealthcare, ASIC may also use UnitedHealthcare’s medical policies as guidance. These policies are available on UHCprovider.com/policies.

Notification does not guarantee coverage or payment (unless mandated by law). We determine the member’s eligibility. For benefit or coverage information, please call the phone number on the back of the member’s health care ID card.

Michigan Law Regarding Diabetes
Michigan law requires us to provide coverage for some diabetic expenses. It also requires us to establish and provide a program to help prevent the onset of clinical diabetes. We have adopted the American Diabetes Association (ADA) Clinical Practice Guidelines published by the ADA.

The program focuses on best practices to help prevent the onset of clinical diabetes and to treat diabetes, including, but not limited to, diet, lifestyle, physical exercise and fitness, and early diagnosis and treatment. You can find the Standards of Medical Care in Diabetes and Clinical Practice Recommendations at care.diabetesjournals.org.

Subscription information for the American Diabetes Journals is available on the website above or by calling 800-232-3472, 8:30 a.m. to 8 p.m. ET, Monday through Friday. Journal articles are available without a subscription at the website listed above.