Applicable to all states except NC.
You are subject to both the main guide and this supplement. This supplement controls if it conflicts with information in the main guide. If there are additional protocols, policies or procedures online, you will be directed to that location. Refer to the main guide for anything not found in this supplement.
Starting Dec. 1, 2020, rolling out over the next 24-36 months, employer groups previously sold under the name All Savers®
Alternate Funding will now be sold under the new product name UnitedHealthcare Level Funded for the following states:
Diagnostic Catheterization, Electrophysiology Implants, Echocardiogram and Stress Echocardiogram
Request prior authorization for services as described in the Outpatient cardiology notification/prior authorization protocol section of Chapter 7: Medical management
Payer ID 87726
CT scans, MRIs, MRAs, PET scans and nuclear medicine studies, including nuclear cardiology
Request prior authorization for services as described in the Outpatient radiology notification/ prior authorization protocol section of Chapter 7: Medical management
Members receive health plan ID cards with information that helps you submit claims. The cards list the claims address, copayment information and phone numbers.
Follow these steps for fast payment:
If you think your claim was processed incorrectly, call the number on the member’s ID card. If you find a claim where you were overpaid, send us the overpayment within 30 calendar days. If we find a claim was overpaid, payment is due within 30 calendar days.
If you disagree with our decision regarding a claim adjustment, you may appeal.
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).