Responsible for the administration and payment of Property and Casualty programs (including workers’ compensation and auto liability) accessing the OneNet PPO Network. Responsibilities include:
Determining bill eligibility
Providing 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 Network is being accessed.
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 > Network Contact.
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.
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.
OneNet pricing sheets are available in the UnitedHealthcare Provider Portal at uhcprovider.com> Sign In > Claims & Payments > UnitedHealthcare OneNet PPO Pricing. Final payment determination is the responsibility of our clients.
Contact the claimant or 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 access OneNet’s workers’ compensation and auto liability networks.