OneNet General Provider Administration Requirements - OneNet PPO Supplement, 2018 UnitedHealthcare Administrative Guide

OneNet care providers follow Chapter 2: Provider Responsibilities and Standards described in the UnitedHealthcare guide with the noted exceptions:

  • As part of transitions under continuity of customer care, participating care providers should notify current patients accessing them through the OneNet Workers’ Compensation Network of an effective date of termination of their participation agreement at least 30 calendar days prior, or as required under applicable laws. OneNet does not maintain Participant names and addresses and cannot notify Participants on your behalf.
  • Additional exceptions related to benefits, eligibility, online tools and health care ID cards are in other parts of this supplement.

Participant Eligibility

Contact the injured worker’s employer or workers’ compensation carrier or administrator to verify employment and eligibility. ID cards are not usually issued or used for workers’ compensation programs. Injured workers accessing you through the OneNet PPO Workers’ Compensation Network will not present an ID card.

Workers’ compensation insurers, administrators and employers of the injured worker are instructed to advise you of network access, if known, when you call to verify employment. You may wish to ask if the injured worker’s employer, carrier or administrator is contracted with Procura to provide workers’ compensation network access.

Online Services on UHCprovider.com

View workers’ compensation claim pricing sheets by using the UHCprovider.com/claims > Check Claim Status > Go to OneNet PPO Pricing Status Tool.

Pricing sheets show the allowed amount of your claims after the application of OneNet claim pricing. Pricing sheets do not show the final claim adjudication by the payer. It may include billed charges that are non-payable. The workers’ compensation EOB or remittance advice shows these charges.

Because workers’ compensation information is not stored on any UnitedHealthcare member system, you cannot use many of the web tools on UHCprovider.com.

Some unavailable tools include:

  • Determining workers’ compensation eligibility or benefits
  • View patient personal health records
  • Submit advance notifications
  • View your OneNet fee schedule
  • Claim Estimator
  • Claim submission
  • Reprint EOBs
  • Electronic Payments and Statements

Similar limitations exist for other UnitedHealthcare systems designed to utilize or verify benefits and eligibility information, such as the United Voice Portal.