Member ID card information may vary by health benefit plan. For example, some members may have ID cards which indicate M.D.IPA Preferred or Optimum Choice Preferred benefits. You can see an image of the ID card specific to the member when you verify the member’s eligibility. For more information on ID cards and to see a sample health plan ID card, refer to the Health Care Identification (ID) Cardssection of Chapter 2: Provider responsibilities and standards.
Before seeing a member, it is important you verify their eligibility and benefits on the UnitedHealthcare Provider Portal, as well as the member’s PCP selection, to avoid payment issues. Go to uhcprovider.com and click Sign In in the top right corner. Then click Eligibility from the drop down menu.
The following unique features are located on M.D.IPA and Optimum Choice health plan ID cards:
Laboratory provider information is located on the front of the cards; see the Laboratory Requirements section of this supplement.
Radiology county information is located on the front of the cards; see the Radiology Services section of this supplement.
Information regarding the necessity of referral and prior authorization requirements is now listed on the back of the cards.
M.D.IPA and Optimum Choice members must use the medical laboratory noted on their ID card for medical laboratory services. Any specimens collected in the office MUST be sent to the laboratory indicated on the member’s ID card. Depending on where the member lives, the ID card shows:
LAB = LABCORP (Laboratory Corporation of America).
LAB = PAR (may use any participating outpatient commercial medical laboratory). Our online directory of health care professionals is available on uhcprovider.com/findprovider.
M.D.IPA and Optimum Choice members must use the radiology county noted on the ID card. Depending upon the member’s PCP’s office location, the ID card shows:
RAD = PAR (may use any office based participating provider). A complete list of these providers may be found on uhcprovider.com/findprovider.
RAD = County (the name of a county, i.e., “MONT [Montgomery County]” is listed on the card).
A complete list of county specific radiology vendors is found on uhcprovider.com/plans> Choose Your State > Commercial > Radiology Vendors.
Verify the member’s copayments when verifying their eligibility.
Member PCP requirements
A PCP is defined as a physician specializing in family practice, internal medicine, pediatrics, or general practice. Other health care providers will be included as primary physicians as required by state mandates. Members are required to see their PCP or a covering physician at the address location that shares the same TIN listed on the Patient Eligibility screen. Some PCPs have multiple TINs but may not participate under each of those TINs for the member’s benefit plan. Before scheduling an appointment, verify the member’s assigned PCP and TIN (listed on the Patient Eligibility screen) matches the TIN address where the member will be seen. Submit your address corrections through My Practice Profile in the UnitedHealthcare Provider Portal, or call the phone number on the back of the member’s ID card before seeing the member.
For requests about panel status (i.e., Open/Closed to New/Existing Patients), contact your Network Account Representative 30 calendar days before any action. To find your Network Account Representative, go to uhcprovider.com > (scroll down) > Contact Us > Find a Network Contact > Select your state. Members are required to select a network PCP, or a PCP is auto-assigned.
Direct access services
Female members may receive OB/GYN physician services directly from a participating OB/GYN, family practice physician, or surgeon identified by the medical group/IPA or UnitedHealthcare as providing OB/GYN physician services. This means the member may receive these services without prior authorization or a referral from the member’s PCP. In all cases, the physician must be affiliated with the member’s assigned medical group/IPA and participating with UnitedHealthcare.