Convenience Care Clinics Expands Member Services Asthma … · 2019-06-20 · Health Clinics...

For more information

Call our Provider Service Centerat 800-557-9933

Visit UHCCommunityPlan.com

In This Issue:

• Convenience Care Clinics ExpandsMember Services . . . . . . . . . . . . . . . . . 1

• Physician Satisfaction SurveyUnderway . . . . . . . . . . . . . . . . . . . . . . . 2

• Prompt Responses to MedicarePart D Prescription Appeals InquiriesEnsure Continuity of Care . . . . . . . . . 2

• New Clinical Guidelinesfor UnitedHealthcare CommunityPlan . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

• National Institute for MentalHealth Resources: Focus onMedications . . . . . . . . . . . . . . . . . . . . . 3

• When Forces Collide: TraumaticBrain Injury Masquerading asADHD in Adolescents . . . . . . . . . . . . 3

• UnitedHealthcare CommunityPlan Provider Portal Online-Authorizations and NotificationProcess . . . . . . . . . . . . . . . . . . . . . . . . . 6

• Getting Started with EDI is simple . . 7

Important information from UnitedHealthcare Community Plan for physicians and other health care professionals and facilities serving Medicaid and Medicare members.

Convenience Care Clinics Expands MemberServicesUnitedHealthcare Community Plan has recently expanded ourprovider network to include walk-in clinics at various TakeCareHealth Clinics (Walgreens) and Minute Clinics (CVS) stores inOhio, Texas, New York,Wisconsin, Mississippi and Delaware.When provided with primary care physician information, theconvenience care clinic will make every attempt to submitnotification to that primary care physician to ensure continuityand quality of care. Convenience care clinic staff do not assistpatients with referrals for specialty care services. Convenience careclinics treat patients over the age of 19 months and will not beoffering immunizations for the vaccine for children (VFC)program in this setting. Convenience Care Clinics offer extendedhours, and in most cases are open until 8:00 pm.

Some common conditions that can be treated in the conveniencecare clinics:

Vaccines• Flu (seasonal)• Hepatitis A (adult)• Hepatitis (adult)• Meningitis• Pneumonia• Td (Tetanus, Diphtheria)

Fall 2012

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New Mexico | Spring 2013

For more information

Call our Provider Service Center at 877-236-0826

Visit UHCCommunityPlan.com

Asthma Action PlansAccording to the US Centers for Disease Control (CDC), the number of people with asthma continues to grow. One in 12 people (about 25 million, or eight percent of the population) had asthma in 2009, compared with one in 14 (about 20 million, or seven percent) in 2001. More than half of people with asthma had an asthma attack in 2008 and 3,262 adults died from asthma in 2007.*

Current clinical practice guidelines for asthma care as outlined by the National Heart Lung and Blood Institute include patient centered action plans. These individual action plans are flexible to the patients’ needs and allow self-management by providing essential skills to control asthma, prevent exacerbations and improve health outcomes.

You may also adjust action plans to include additional treatments from interdisciplinary team members. Action plans help reinforce information during office visits and copies can be made for caregivers, school personnel and family members.

For a free copy of an action plan, visit http://www.nhlbi.nih.gov/health/public/lung/asthma/asthma_actplan.htm.


In This Issue:• Asthma Action Plans ............................ 1

• How to File an Appeal and/or Grievance on Behalf of a Member ........ 2

• Medical Technology Assessment Committee ........................ 2

• Medicare – Improving Health Care Quality .......................... 3

• Medicare Advantage and Prescription Drug Plans .................... 3

• Pertussis Myths and Facts ..................... 4

• Utilization Management ....................... 5

• Recognizing COPD ............................. 6

• Member Rights and Responsibilities .... 6

• New Mexico Child Safety Seat Distribution Program ............................ 6

• Depression and Diabetes ...................... 8

• UnitedHealthcare and AAPC Partner on ICD-10 ............................... 9

• Prior Authorization Review Required for Select Injectable Medications for UnitedHealthcare Community Plan Members .................. 9

• 2012 Annual Physician and Practice Manager Survey Results ..................... 11

• Clinical Practice Guidelines ................ 11

http://www.uhccommunityplan.com/

http://www.nhlbi.nih.gov/health/public/lung/asthma/asthma_actplan.htm

http://www.nhlbi.nih.gov/health/public/lung/asthma/asthma_actplan.htm

How to File an Appeal and/or Grievance on Behalf of a MemberAppealIf UnitedHealthcare Community Plan of New Mexico denies a request for authorization, you and the member will receive a letter with the reason for the denial and member rights and information on how to request an appeal. Appeals must be requested within 90 days of the date of the denial letter. You must have written permission from the member to act on his or her behalf.

GrievanceA grievance is an expression of dissatisfaction about any matter or aspect of UnitedHealthcare Community Plan or its operation. A member may submit a grievance within 90 calendar days from the date of the event causing the dissatisfaction.

For more information about the member grievance and appeal process, please see the Provider Administrative Manual or the member handbook at UHCCommunityPlan.com.

Submit member Appeals and Grievances via mail or fax to:

UnitedHealthcare Community Plan UnitedHealthcare CoLTS Appeals & Grievances P.O. Box 31364 Salt Lake City, UT 84131-0364 Fax: 877-275-6030

Medical Technology Assessment Committee The Medical Technology Assessment Committee (MTAC) meets at least 10 times per year. Its reports are reviewed by the National Medical Care Management Committee and recommendations are forwarded to the National Quality Management Oversight Committee and disseminated to the health plans.

MTAC is responsible for developing and managing:

• Evidence-based position statements on selected medical technologies.

• Assessments of the evidence supporting new and emerging technologies.

You may view the 2007 National Asthma Education and Prevention Program Expert Panel Report 3 Guidelines for the Diagnosis and Management of Asthma at nhlbi.nih.gov/guidelines/asthma/index.htm

*CDC.gov


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NM - Spring 2013 Provider Service Center: 877-236-0826

Important information for health care professionals and facilities

I Fall 2012 2 Provider Service Center: 800-557-9933

Illnesses• Bladder infection treatment (females 12-65)• Bronchitis (ages 10-65)• Laryngitis• Ear infections• Pinkeye and styes• Sinus infections (ages five and up)• Strep throat• Swimmer’s ear

Skin Conditions• Athlete’s foot• Acne• Cold sores (ages 12 and up)• Deer tick bites (ages 12 and up)• Impetigo• Minor burns and rashes• Minor sunburn• Poison ivy (ages three and up)• Scabies• Shingles• Ringworm• Swimmer’s itch (ages three and up)

Other servicesFlu diagnosis (ages 10-64)• Mononucleosis• Pregnancy testing

Physician Satisfaction SurveyUnderway

The annual PhysicianSatisfaction Survey processhas begun, and you shouldhave received your first faxnotification. There willbe two more invitations toparticipate before thesurvey closes in October.

Your response letsUnitedHealthcareCommunity Plan know

how we can improve our working relationshipand better meet the needs of your practice. Welook forward to your participation in the surveyprocess.

Prompt Responses to Medicare Part DPrescription Appeals Inquiries EnsureContinuity of Care

When you or your patient, files an appeal withUnitedHealthcare, we will contact your office viafax or phone to request certain key informationneeded as part of the appeal process.

By federal law, UnitedHealthcare must render anappeal decision within 72 hours for an expeditedrequest and seven calendar days for a standardrequest.

Your assistance in responding to these requestspromptly helps ensure continuity of themember’s treatment plan.

New Clinical GuidelinesUnitedHealthcare Community Plan

UnitedHealthcare Community Plan Pharmacyand Therapeutic Committee has approved a newclinical guideline for Antiemetic ContinuousPump Therapy for the Treatment of Nausea andVomiting in Pregnancy.

Notification - Effective Oct. 1, 2012, the use ofAntiemetic Medication through a continuoussubcutaneous pump in the treatment of nauseaand vomiting in pregnancy will no longer becovered under UnitedHealthcare CommunityPlan.

Providers may request clinical review criteria bycontacting the Pharmacy Prior Notificationdepartment at 800-310-6826.



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http://UHCCommunityPlan.com

http://nhlbi.nih.gov/guidelines/asthma/index.htm

http://CDC.gov

• Evaluation of new usage of existing technologies.

• Maintenance of externally licensed guidelines.

• Consideration and incorporation of nationally accepted consensus statements, clinical guidelines and expert opinions into the establishment of national standards for UnitedHealthcare.

• Ensuring clinical decisions about the safety and efficacy of medical care are consistent across all products and businesses.

Medicare – Improving Health Care QualityOur health care plans reflect the excellent care you provide your patients. By taking a big picture view of quality, incorporating feedback from your patients’ health care experience and working with you, we can provide higher quality health care plans and together, help your patients who are our members live healthier lives.

UnitedHealthcare’ s quality initiatives touch every claim, phone call and physician visit and our evidence-based wellness and care management programs help members achieve the best possible health together with physicians and the support of our own clinicians. We have built a quality infrastructure to measure our performance and quality – and make health care simpler and more efficient.

Cooperation With Quality Improvement ActivitiesAll participating physicians and providers must cooperate with all quality improvement activities. These include, but are not limited to:

• Timely provision of medical records upon request by us or our contracted business associates.

• Cooperation with quality of care investigations including timely response to queries and completion or improvement action plans.

• Participation in quality audits, including site visits and medical record standards reviews, and annual Health Care Effectiveness Data and Information Set (HEDIS®) record review.

• If we request medical records, physicians must provide copies of such records free of charge during site visits or via email, secure email or secure fax.

Medicare Advantage and Prescription Drug PlansSeveral industry quality programs including the Centers for Medicare & Medicaid Services (CMS) Star Ratings provide external validation of our Medicare Advantage and Part D plan performance and quality progress. Quality scores are provided on a one to five star scale, with one star representing the lowest quality and five stars representing the highest quality. Star Ratings scores are derived from four sources:

1. Consumer Assessment of Healthcare Providers and Systems (CAHPS) or patient satisfaction data.

2. Health Care Effectiveness Data and Information Set (HEDIS) or medical record and claims data.

3. Health Outcomes Survey (HOS) or patient health outcomes data.

4. CMS administrative data on plan quality and member satisfaction.

To learn more about CMS Star Ratings and view current CMS Star Ratings for Medicare Advantage and Part D plans, visit the CMS consumer website.






















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Pertussis Myths and FactsNew Mexico Department of HealthMyth: Pertussis is not a problem in New Mexico.

Fact: New Mexico is currently experiencing an outbreak of pertussis with 727 confirmed and probable cases this year. 65 of these cases are infants less than 12 months old. Hispanics are also disproportionately affected, with 60 percent of cases affecting this group. Pertussis has already caused one infant death in New Mexico this year.

Myth: Babies get shots, so my baby will be protected against pertussis.

Fact: Infants immunizations against pertussis are not completed until six months of age. This leaves infants, especially those under six months of age, vulnerable to pertussis and its potentially fatal symptoms.

Myth: I don’t have a “whoop” so I couldn’t possibly have “whooping cough.”

Fact: Not everyone with pertussis has a whoop. Very young infants may not have a cough at all, but instead may present with gasping, gagging and cyanosis (turning blue). Adolescents and adults may present with a prolonged unexplained cough and none of the other symptoms associated with pertussis. Consider pertussis in anyone with a cough of two weeks or longer for which no other diagnosis can be made.

Myth: Patients diagnosed and treated with an appropriate antibiotic for pertussis who continue to cough after treatment should get a second course of antibiotic.

Fact: There is no known antibiotic resistance to pertussis, so there is no need for multiple courses of antibiotic. It is the toxins that the

bacteria produces that cause damage to the airway, and these toxins persist even after the bacteria are killed. Patients should be treated with an appropriate macrolide antibiotic (azithromycin, clarithromycin or erythromycin). If they are unable to tolerate macrolides, trimethoprim-sulfamethoxasole (Bactrim-DS) twice a day for 14 days is an acceptable alternative.

Myth: Children who are fully immunized cannot get pertussis.

Fact: Forty percent of all pertussis cases in New Mexico in 2012 occurred in fully immunized children. It is known that 15-20 percent of children who are fully immunized do not develop adequate immunity to prevent infection and recent data suggests that immunity starts to wane sooner than was previously assumed.

Myth: I received a Td shot (tetanus booster) recently, so I can’t get the Tdap.

Fact: There is no minimum interval between receiving a tetanus booster and getting a Tdap vaccine. CDC currently recommends all adults receive a Tdap vaccine regardless of when they last received a Td shot.

Myth: Patients diagnosed with pertussis can return to work or school or other group activities within 24 hours of starting an appropriate antibiotic.

Fact: Patients with confirmed or suspect pertussis must remain isolated at home for the first five days of appropriate antibiotic treatment. Pertussis is highly contagious. This means no school, work, church or going to the gym.





















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Utilization ManagementUpdate - Access to Utilization Management Staff The Utilization Management department is available 8 a.m. to 5 p.m., Monday through Friday at 877-236-0826 and select Prior Authorizations. Please have your tax ID number and member information available. Representatives can answer questions about the utilization management process including prior authorization, inpatient notification and criteria used for decision-making.

You may also fax requests for prior authorization to 866-968-7582. Prior authorization requirements are outlined in the Prior Notification Guide for In-Network Providers. For a copy, contact your Provider Advocate or visit UHCCommunityPlan.com.

Prior authorization includes:

• Ambulatory/outpatient procedures.

• Ablation procedures for venous insufficiency and varicose veins.

• Gynecomastia/for medical necessity.

• Rhinoplasty, septoplasty and turbinate resection authorization - required if medically necessary.

• Panniculectomy and body contouring procedures.

• Video EEG.

• Pulmonary rehabilitation services.

• Plagiocephaly.

• Reconstructive surgery.

• Botox for medical necessary equipment.

• Cochlear implants.

• Bone growth stimulators.

Processes continue:

• DME > $1,000.00 continue to need prior authorization.

• Several Not a Covered Benefit (NCB) services and procedures per state regulations are outlined in the Prior Authorization Guide, including gastric bypass surgery.

• For prior authorization for UnitedHealthcare Community Plan members call 800-537-2977. Non-emergent, medically necessary transportation and lodging can be requested by calling Logisticare at 866-400-8233.

• Native American members who access services via Indian Health Services providers do not require prior-authorization for services.

• Out-of-network providers require prior authorization on all services and DME.

• For questions and evaluation of organ transplants contact our Optum Transplant Team: 800-418-4994 option 5 or fax 877-814-0488.

• Requests for Early and Periodic Screening, Diagnosis and Treatment (EPSDT) under the age of 21 call 877-236-0826 prompt service coordination and ask for the EPSDT Coordinator.

• Requests for Home Community Base Services (HCBS), call 877-236-0826 option service coordination for C Waiver members.

• Attendant care services (Available to PCO/CCW members).

• Assisted living services.

• Environmental modifications (limited to $5,000 every five years).

• Private duty nursing/waiver.

• Respite services (limited to 100 hours per ISP Year).

• Emergency response system.

• Transition goods and services.

• Adult day care.





















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Recognizing COPDAccording to the National Institute of health, more than 12 million people have a diagnosis of COPD and another 12 million may have undiagnosed COPD. COPD can be well-controlled, but it’s critical to diagnose it early and to follow the appropriate therapeutic strategies, said James Kiley, Ph.D., director of the Division of Lung Diseases at the National Heart, Lung, and Blood Institute.

The spirometry test is the Global Initiative for Chronic Obstructive Lung Disease (GOLD) standard for diagnosis and repeatable measurement of lung function. This test can be performed in the primary care setting at a relatively low cost. Spirometry measures the volume of air a person can expel after maximal inspiration and is the most accurate and reliable way of supporting a diagnosis of COPD. These values are compared with normal values based upon gender, height, weight and ethnicity to provide a mild, moderate or severe disease level.

Screening for this preventable and treatable disease requires the identification of COPD clinical features:

• Chronic cough, which may be daily and productive or intermittent and unproductive.

• Breathlessness on exertion, initially intermittent and becoming persistent.

• Sputum production: any patter of sputum production may indicate COPD.

• Frequent exacerbations of bronchitis.

• A history of exposure to risk factors, especially tobacco smoke, occupational dusts, home cooking and biomass fuels.

GOLD guidelines for patients 40 and older recommend performing spirometry when any of these clinical indicators are present.

For more information related to COPD Clinical Guidelines, visit 2010 Global Initiative for Chronic Obstructive Lung Disease.

Member Rights and ResponsibilitiesUnitedHealthcare Community Plan’s Member Rights and Responsibilities can be found in the provider manual at UHCCommunityPlan.com. These are distributed to new members upon enrollment and annually.

New Mexico Child Safety Seat Distribution Program The New Mexico Child Safety Seat Distribution Program provides education and instruction on child safety seat use and installation at hospitals and healthcare facilities statewide. The program also distributes free or reduced-cost car seats and booster seats to low-income families who meet program requirements. For more information, go to safernm.org/Child_Passenger_Safety/Main/Car_Seat_Programs.html.






















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http://safernm.org/Child_Passenger_Safety/Main/Car_Seat_Programs.html



NMCSSDP Providers

Alamogordo Ben Archer Health Center

Albuquerque 377th Medical Group Kirtland Air Force Base John Marshall Health and Social Service Center Lovelace Women’s Hospital Presbyterian Healthcare Services Trumbull Family Resource Center University of New Mexico Hospital/Pediatric ER University of New Mexico Hospital/Special Care Nursery

Anthony La Clínica de Familia

Artesia Eddy County WIC Office

Carlsbad Eddy County WIC Office

Chaparral La Clinica de Familia

Crownpoint Crownpoint Healthcare Facility

Deming Luna County Healthy Start

Española Española Hospital

Farmington Childhaven

Gallup Gallup Indian Medical Center Rehoboth McKinley Christian Hospital

Grants Cibola General Hospital

Hatch Ben Archer Health Center

Hobbs Lea County WIC Office

Kewa Pueblo Kewa Pueblo CHR Program

Las Cruces Ben Archer Health Center Doña Ana County Health & Human Services First Step Women’s Center La Clinica de Familia

Las Vegas Alta Vista Regional Hospital

Los Lunas Youth Development, Inc.

Lovington Lea County WIC Office

Moriarty Torrance County Project Office

Roswell Chaves County MCH/Reach 2000 Chaves County WIC Office

Ruidoso Lincoln County Medical Center

San Felipe Pueblo San Felipe Katishtya Injury Prevention Program

San Miguel La Clinica de Familia























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NMCSSDP Providers (Continued)

Santa Fe La Familia Medical Center Christus St. Vincent’s Hospital

Shiprock Northern Navajo Medical Center

Socorro Socorro General Hospital

Sunland Park La Clinica de Familia

Taos Holy Cross Hospital State of New Mexico Public Health WIC Program

Tierra Amarilla La Clinica del Pueblo de Rio Arriba

Zuni Pueblo Zuni PHS/IHS Hospital

Depression and DiabetesEight out of 100 Americans have diabetes. This disease drastically impacts New Mexicans with Native Americans and Hispanics having higher rates of diabetes.

A new or added diagnosis such as diabetes can cause emotional stress and personal difficulties include sadness, anxiety and anger along with a need for major lifestyle changes. These changes can lead to coping problems and sometimes more serious anxiety or mood disorders, like depression, and depression can worsen the effects and management of diabetes.

Patients exhibiting the following symptoms for two weeks or longer may have depression:

1. Loss of pleasure in everyday life.

2. Sleeping too much or too little.

3. Low energy.

4. Poor concentration.

5. Guilty or nervous feelings.

6. Thoughts of harming oneself.

7. Isolation.

Some individuals lose their appetite or consume drugs or alcohol to cope with depression. If patient with diabetes has depression, it is important to evaluate the need for help from a behavioral health specialist. Patients with co-morbid conditions can be at higher risk for increased complications and hospitalizations when not treated holistically by a primary care team.

If a patient is having difficulty adjusting to a new diagnosis or otherwise has symptoms of depression, refer him or her to a trained behavioral health professional who can help with coping skills and strategies and may recommend other interventions such as psychotropic medication and/or support groups. It is also important for the patient to develop and maintain a support system. Friends, family and the primary care physician and other specialists can offer care and assistance.

Patients perceive illness or disease based on life experiences and cultural beliefs. Try to recognize these differences and offer options in a culturally sensitive manner. Asking basic questions about their understanding of their illnesses and ways they need support will help engage and enhance an individual’s adherence to their care plan. Most important, helping the patient feel understood is one of the keys to acceptance and can promote self-care and mastery in the stabilization and recovery from a disease.






















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UnitedHealthcare and AAPC Partner on ICD-10UnitedHealthcare has teamed up with the American Academy of Professional Coders (AAPC) to offer our contracted network partners access to the industry-leading ICD-10 (International Classification of Diseases, Tenth Revision) training and tools at a significant discount off the normal retail price.

This option will complement the free educational materials, tools and resources that UnitedHealthcare has created to help your practice transition to ICD-10.

ICD-10, with the associated increases in the number of codes, characters per code and coding specificity, is expected to require significant investment from a planning, training and IT infrastructure perspective for many practices and facilities.

AAPC’s ICD-10 trainings provide continuing education units, and where applicable continuing medical education credits, and are designed to overcome the more complex challenges faced by both physicians and physician based coders as they transition to ICD-10.

For more information and to access the AAPC’s education and tools at the UnitedHealthcare discounted rates, please visit UnitedHealthcareonline.com.

Prior Authorization Review Required for Select Injectable Medications for UnitedHealthcare Community Plan MembersEffective for service dates on or after Apr. 1, 2013, physicians will be required to obtain prior authorization before administering certain drugs covered under the medical benefit for UnitedHealthcare Community Plan members, including those currently on therapy.

Note: Prior authorization for these medications is not required for services that take place in an emergency room, observation unit or urgent care facility or during an inpatient stay.

Impacted medications include the following:*

(Please note health plan exceptions for Synagis, Acthar HP, and Xolair below.)

J Code J Code Description Brand Name

J0585 Botulinum Toxin Type A, per Unit Botox

J0586 Injection Abobotulinumtoxina, 5 Units Dysport

J0587 Botulinum Toxin Type B, 100 Units Myobloc

J0588 Injection, Incobotulinumtoxina, per Unit Xeomin

J0800 Injection Corticotropin, up to 40 Units Acthar HP1

J1459 Injection IG IV Nonlyophilized 500mg Privigen

J1557 Injection, Immune Globulin, Intravenous, Nonlyophilized, 500mg Gammaplex

J1559 Injection, Immune Globulin, 100 mg Hizentra






















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https://www.unitedhealthcareonline.com/b2c/CmaAction.do?channelId=6fa2600ae29fb210VgnVCM1000002f10b10a____

CPT CPT Description Brand Name

90283 Immune Globulin, IV, Human, for Intravenous use Intravenous Immune Globulin

90284 Immune Globulin Human, for use in Subcutaneous Infusions Subcutaneous Immune Globulin

90378 RSV Immune Globulin for Intramuscular use, 50mg Synagis3

1 Acthar HP – Prior authorization on the medical benefit applies to all health plans except Arizona. 2 Xolair – Prior authorization on the medical benefit only for Delaware, Tennessee, Nebraska, Texas and Wisconsin. 3 Synagis – Prior authorization on the medical benefit only for Delaware, Texas and Wisconsin.

*This list is subject to change as new immune globulin medications, CPT code and/or J codes are released.

J Code J Code Description Brand Name

J1561 Injection Immune Globulin, IV, 500 mg Gammaked, Gamunex, Gamunex-C

J1566 Injection, Immune Globulin, IV, Lyophilized, 500mg Carimune NF, Gamimune N, Gammagard S/D, Iveegam

J1568 Injection, Immune Globulin, IV, Nonlyophilized, 500mg Octagam

J1569 Injection, Immune Globulin, IV, Nonlyophilized, 500mg Gammagard Liquid

J1572 Injection, Immune Globulin, IV, Nonlyophilized, 500mg Flebogamma/Flebogamma Dif

J1599 Injection, Immune Globulin, IV, Nonlyophilized, not Otherwise Specified, 500mg

Gamunex

J1725 Injection, Hydroxyprogesterone Caproate, 1mg Makena

J2357 Injection Omalizumab 5mg Xolair2

Medical Necessity Review ExplainedMedical necessity review addresses clinical evidence supporting use of a health service, its medical appropriateness for a particular patient and its cost-effectiveness. A treatment is considered medically necessary if it meets the following criteria:

• Performed per Generally Accepted Standards of Medical Practice.

• Clinically appropriate, in terms of type, frequency, extent, site and duration, and considered effective for your condition, disease or its symptoms.

• Not administered mainly for convenience of the member or health care professional.

• Not more costly than an alternative drug, service(s) or supply that is at least as likely to produce equivalent therapeutic or treatment results.

In accordance with Medicaid requirements, if a physician fails to obtain prior authorization approval before administering the product, the claim will be denied and the member may not be billed for the service. UnitedHealthcare’s standard appeal processes apply to any denied claim.

For prior authorization questions, contact your local network manager, call the provider services number on the member’s ID card or visit UHCCommunityPlan.com.






















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2012 Annual Physician and Practice Manager Survey ResultsThank you to all who completed our 2012 Physician and Practice Manager Satisfaction Survey.

The annual survey, conducted and analyzed by an independent third party, is an important tool for measuring our performance and identifying areas for improvement.

Overall survey participation increased this year by 3.8 percent among physicians and 6.9 percent among practice managers. Based in part on the feedback you provided in the survey, we will share details about our resulting improvement plans and efforts to strengthen and build network relationships.

Thank you again for your participation.

Clinical Practice GuidelinesClinical Practice Guidelines are available at UHCCommunityPlan.com. Click on your state and link to the CPGs, or call 877-236-0826 for a copy.





















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New Mexico

Provider Service Center: 800-557-9933

Practice Matters is a quarterly publication for physicians and other health care professionals and facilitiesin the UnitedHealthcare network.

M47507MS 8/12 © 2012 UnitedHealth Group, Inc. All Rights Reserved.

795 Woodlands ParkwaySuite 301Ridgeland, MS 39157


UnitedHealthcare Community Plan now offers Real-time 270/271 Electronic Health Care EligibilityInquiry and ResponseTransactions and Real-time276/277 Electronic Health Care Claim Status Inquiryand ResponseTransactions as a quick and easy way tostreamline administrative tasks..

This information is also available through the SecureProvider Portal and by phone, however real timetransactions save your office that added step.

Please see the Companion Guides located within theEDI Section on your State’s home page onUHCCommunityPlan.com for setup guidelines.

Electronic Claim SubmissionTips• Include your tax identification number (TIN) alongwith your NPI number.

• Member ID numbers are required.

• The Payer ID number indicates where clearinghousesshould direct their claims.

8220 San Pedro NESuite 300Albuquerque, NM 87113

UHC2439q_20130301 © 2013 UnitedHealth Group, Inc. All Rights Reserved.

Practice Matters is a quarterly publication for physicians and other health care professionals and facilities in the UnitedHealthcare network.

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Convenience Care Clinics Expands Member Services Asthma … · 2019-06-20 · Health Clinics...

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