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OneNet General Provider Administration Requirements - 2019 UnitedHealthcare Administrative Guide

OneNet General Provider Administrative Requirements

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 Agreement at least 30 calendar days prior, or as required under applicable laws. OneNet does not maintain Participant  names and addresses and may not 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 acceptance of workers’ compensation injury for purposes of coverage. 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 the injury and coverage. 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 Link > United Healthcare OneNet PPO pricing. 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 nonpayable. The workers’ compensation EOB or remittance advice shows these charges.

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

Some unavailable tools include: 

  • 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 
  • Authorizations and referral information, submission and status.

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