Diagnostic catheterization, electrophysiology implants, echocardiogram and stress echocardiogram
Where to go:
Online: uhcprovider.com/paan
Information: uhcprovider.com/cardiology
Phone: 1-866-889-8054
Requirements and Notes:
Request prior authorization for services as described in the Outpatient cardiology notification/prior authorization protocol section of Chapter 7: Medical management.
Where to go:
Electronic Claims Submission: Payer ID 81400
Paper Claims Submission: Mail to the address listed on the back of the member’s ID Card.
Where to go:
Online: uhcprovider.com/priorauth and select the specialty you need.
Where to go:
Online: uhcprovider.com/priorauth > Oncology
Phone: 1-888-397-8129
Requirements and Notes:
Policies and instructions
Where to go:
Prior Authorizations Phone: 1-800-711-4555
Benefit Information: Call the number on the back of the member’s ID Card.
Requirements and Notes:
For information on the Prescription Drug List (PDL), myallsaversconnect.com
Where to go:
Online: uhcprovider.com/paan
Information: uhcprovider.com/priorauth (Policies and instructions)
Phone: 1-800-999-3404
Requirements and Notes:
Prior authorization and notification is required as described in Chapter 7: Medical management. EDI 278A transactions are not available.
CT scans, MRIs, MRAs, PET scans and nuclear medicine studies, including nuclear cardiology
Where to go:
Online: UHCprovider.com/paan
Information: uhcprovider.com/radiology
Phone: 1-866-889-8054
Requirements and Notes:
Request prior authorization for services as described in the Outpatient radiology notification/prior authorization protocol section of Chapter 7: Medical management
ASIC members receive health plan ID cards with information that helps you to submit claims. The cards list the claims address, copayment information, and phone numbers.
A sample ID card and more information is in the Health plan identification (ID) cards section in Chapter 2: Provider responsibilities and standards.
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 2-step process available for review of your concern. Step 1 is a Claim Reconsideration. If you disagree with the outcome of the Claim Reconsideration, you may request a Claim Appeal (step 2).
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: 1-801-478-5463
Phone: 1-800-291-2634
If you feel the situation is urgent, request an expedited appeal by phone, fax, or writing:
Grievance Administrator
2020 Innovation Dr.
DePere, WI 54115
Expedited Fax: 1-866-654-6323
Phone: 1-800-291-2634
Time frame
You must submit your claim reconsideration and/or appeal to us within 12 months (or as required by law or your Agreement), from the date of the original EOB or denial. The 2-step process allows for a total of 12 months for timely submission, not 12 months for step 1 and 12 months for step 2.
What to submit
As the health care provider of service, you submit the dispute with the following information:
If you disagree with the outcome of the claim appeal, you may file for an arbitration proceeding. A description of this process is in your Agreement.
Refer to Claim reconsideration and appeals process section in Chapter 10: Our claims process, for more information.
To verify ASIC members’ benefits, call the number on the back of the member’s ID card.
ASIC uses tools developed by third parties, such as InterQual Care Guidelines, to help manage health benefits and to assist clinicians in making 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, call the phone number on the back of the member’s ID card.
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.
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. 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 1-800-232-3472, 8:30 a.m. – 8 p.m. ET, Monday–Friday. Journal articles are available without a subscription at the website listed above.