Who to contact, OneNet PPO supplement - 2021 UnitedHealthcare Administrative Guide

Responsible for the administration and payment of workers’ compensation and auto liability programs accessing the OneNet PPO Network. Responsibilities include:

  • determining bill eligibility
  • processing bills
  • providing explanation of benefit (EOB) statements or remittance advices
  • may also include case management and utilization review services.

Where to go: 

For questions related to these services, contact the payer identified on the EOR or the payer provided by the patient. Procura and OneNet names will appear on the EOR/EOB/remittance advice when the OneNet PPO Workers’ Compensation or Auto Network is being accessed.

For OneNet PPO in-network referrals, OneNet contracted rate pricing inquiries/ appeals, or how to contact our clients.

Where to go: 

Where to go: 

Contact your UnitedHealthcare Network Management representative. If you require assistance determining who your representative is, or how to reach them, visit UHCprovider.com > Contact Us > Find a Network Contact.

Where to go: 

If you are disputing state pricing or services deemed not part of the workers’ compensation/auto illness or injury, contact the client at the number identified on the EOR.

For all network-related concerns, contact Procura:

Some states have formal dispute resolution or appeals processes. Follow the appeal time frames and dispute resolution procedures outlined in your contract and this guide. Contact Procura if you have questions about this requirement.

 

Where to go: 

Contact the payer identified on the EOR. DPR Plan provides specific requirements for submitting an appeal for medical reconsideration of an auto liability claim, but they are not required in all states.

Where to go: 

OneNet pricing sheets are available on UHCprovider.com > Link > UnitedHealthcare OneNet PPO Pricing. Final payment determination is the responsibility of our clients.

Where to go: 

For information on policies, protocols, products, new initiatives, website enhancements and tools for you, visit: UHCprovider.com/news

Patient eligibility

Contact the injured worker’s employer, workers’ compensation carrier, auto liability insurer or administrator to verify acceptance of an injury for purposes of coverage. ID cards are not usually issued or used for workers’ compensation and auto liability programs. Injured workers and claimants accessing you through the OneNet PPO Network will not present an ID card. Insurers, administrators and employers are instructed to advise you of network access, if known, when you call to verify the injury and coverage. You may ask if the employer, carrier or administrator is contracted with Procura to provide workers’ compensation or auto liability network access.