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2020 Medicare Advantage Plan Overview Indiana Care Provider Education Session
[DATE]
Welcome • UnitedHealthcare’s Mission
• Medicare Advantage Plan Types
• What’s New for 2020
• Getting Ready for Medicare’s Annual Enrollment Period
• Available 2020 Indiana Plans
• Recognizing Our Plans
• Doing Business with Us
OUR MISSION
To help people live healthier lives and to help the health care system
work better for everyone.
UnitedHealthcare Medicare Advantage Plan Types
4 © 2020 United HealthCare Services, Inc. All rights reserved. PCA-1-20-00217-M&R-PRES_01222020
• Health Maintenance Organization (HMO) – A defined network of contracted local physicians and facilities to provide care.
• Point of Service (HMO-POS) – Includes all the features of an HMO plus the ability to go outside the
contracted network for certain health care services – typically at a higher cost. POS plans do not need referrals for specialty care.
• Preferred Provider Organization (PPO) – Offers members access to a network of contracted
physicians and facilities, but also allows them the flexibility to seek covered services from outside of the contracted network – usually at a higher cost. Members do not need a referral for specialty care.
• PPO plans are available as either local PPO (LPPO) – certain counties within a state – or regional PPO (RPPO) offerings. RPPOs serve a larger geographic area – either a single state or a multi- state area. RPPOs offer the same premiums, benefits and cost-sharing requirements to all members in the region.
• Private Fee-for-Service (PFFS) – Allows members the option to seek care from any Medicare-eligible
care provider without a referral – as long as the care provider agrees to the plan's terms, conditions and payment rates.
• Includes a wide variety of health care benefits – often at a lower cost than Original Medicare.
Getting Ready for the Annual Enrollment Period
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What is the Annual Enrollment Period (AEP)? During Medicare’s AEP, which runs from Oct. 15 – Dec. 7 each year, Medicare-eligible enrollees can enroll, switch or drop a Medicare Advantage plan or prescription drug plan for the upcoming calendar year.
What does AEP mean for care providers and staff? During AEP, eligible enrollees may turn to their care providers to help them determine the right plan.
What information is available? UnitedHealthcare plan information is available at UHCprovider.com/plans > Choose Your State > Medicare > Select Plan Name.
More information on Medicare’s AEP is at medicaremadeclear.com.
© 2020 United HealthCare Services, Inc. All rights reserved. PCA-1-20-00217-M&R-PRES_01222020
What’s New – Plan Name Changes
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• For 2020, we are changing UnitedHealthcare and AARP® Medicare Advantage plan names from MedicareComplete® to Medicare Advantage.
2019 Example Plan Name
AARP® MedicareComplete
UnitedHealthcare MedicareComplete
2020 Example Plan Name
AARP® Medicare Advantage
UnitedHealthcare Medicare Advantage
© 2020 United HealthCare Services, Inc. All rights reserved. PCA-1-20-00217-M&R-PRES_01222020
What’s New – AARP® Logo Enhancements
7 © 2020 United HealthCare Services, Inc. All rights reserved. PCA-1-20-00217-M&R-PRES_01222020
UnitedHealthcare Medicare National Network (PPO)
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• Beginning Jan. 1, 2020, many but not all, UnitedHealthcare- and AARP®-branded PPO plan members will have access to a broader national network of contracted care providers. That means these PPO members will have nationwide access to care at in-network costs using our Medicare national network.
• Care providers already contracted with UnitedHealthcare are automatically included in the national network and would be able to start seeing members in 2020.
• The member’s ID will confirm if the member’s plan includes national network access. • PPO members who have access to the national network would no longer need to activate Passport to
access care outside their local service area. • Only members of participating PPO plans in the following states can access the national network of
care providers: • Arizona • Arkansas • Colorado • Connecticut • Florida • Georgia • Idaho • Illinois • Indiana
• Iowa • Kansas • Kentucky • Massachusetts • Maine • Minnesota • Missouri • Nebraska • New Mexico
• North Dakota • North Carolina • New Hampshire • New York • Ohio • Oklahoma • Oregon • Pennsylvania • Rhode Island
• South Carolina • South Dakota • Tennessee • Texas • Utah • Vermont • Wisconsin • Virginia • West Virginia
Network size varies by market and exclusions may apply.
© 2020 United HealthCare Services, Inc. All rights reserved. PCA-1-20-00217-M&R-PRES_01222020
UnitedHealthcare Medicare National Network (PPO)
Sample member ID cards for illustration only. Actual information varies depending on payer, plan and other requirements.
Members will no longer need to activate Passport to access care outside their local service area for PPO plans.
9 © 2020 United HealthCare Services, Inc. All rights reserved. PCA-1-20-00217-M&R-PRES_01222020
Medicare Advantage Plans in Indiana
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Indiana Market Overview
AARP® Medicare Advantage Profile/Parkview (HMO-POS)
AARP® Medicare Advantage Plan 1 (HMO-POS)
AARP® Medicare Advantage Plan 2 (HMO-POS)
AARP® Medicare Advantage Focus/Lutheran (PPO)
5 AARP® Medicare Advantage Choice (PPO)
AARP® Medicare Advantage Choice Plan 1 (PPO)
AARP® Medicare Advantage Choice Plan 2 (PPO)
AARP® Medicare Advantage/WellMed (PPO & HMO-POS)
UnitedHealthcare Dual Complete®
(PPO SNP)
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In Indiana, we offer the following Medicare Advantage plans:
© 2020 United HealthCare Services, Inc. All rights reserved. PCA-1-20-00217-M&R-PRES_01222020
Medicare Advantage Plans
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Plan Name Plan ID Group Numbers Service Area/Counties
UnitedHealthcare Dual Complete® (PPO SNP)
H0271-005 67200 All Indiana Counties except for Wayne County
AARP® Medicare Advantage Profile (HMO-POS) Parkview
H2802-007 00700, 00701 00746 ,00747
Allen, De Kalb, Huntington, Lagrange, Noble, Whitley
AARP® Medicare Advantage Plan 1 (HMO-POS)
H2802-008 00702, 00703 00748, 00749
Adams, Wells
AARP® Medicare Advantage Plan 1 (HMO-POS)
H2802-010 00704, 00705 00744 ,00745
Bartholomew, Benton, Blackford, Boone, Brown, Carroll, Clinton, Decatur, Delaware, Fayette, Fountain, Hamilton, Hancock, Hendricks, Henry, Howard, Jay, Johnson, Lawrence, Madison, Marion, Monroe, Montgomery, Morgan, Orange, Putnam, Randolph, Rush, Shelby, Tippecanoe, Tipton, Union, Warren, White
AARP® Medicare Advantage Plan 1 (HMO-POS)
H2802-012 00709, 00710 00750, 00751
Crawford, Daviess, Dubois, Gibson, Knox, Martin, Perry, Pike, Posey, Spencer, Vanderburgh, Warrick
AARP® Medicare Advantage Plan 2 (HMO-POS)
H2802-015 00714, 00739 00754
Cass, Elkhart, Fulton, Grant, Kosciusko, Marshall, Miami, St. Joseph, Steuben, Wabash
AARP® Medicare Advantage Plan 1 (HMO-POS)
H2802-016 00740, 00755 00756
Clark, Dearborn, Floyd, Franklin, Harrison, Jackson, Jefferson, Jennings, Ohio, Ripley, Scott, Switzerland, Washington
AARP® Medicare Advantage Plan 1 (HMO-POS)
H2802-018 00742, 00743 00758, 00759
Jasper, La Porte, Lake, Newton, Porter, Pulaski, Starke
AARP® Medicare Advantage Plan 1 (HMO-POS)
H2802-020 00721, 00722 00761, 00762
Clay, Greene, Owen, Parke, Sullivan, Vermillion, Vigo
© 2020 United HealthCare Services, Inc. All rights reserved. PCA-1-20-00217-M&R-PRES_01222020
Medicare Advantage Plans
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Plan Name Plan ID Group Numbers Service Area/Counties
AARP® Medicare Advantage Choice Plan 1 (PPO)
H2228-019 67001, 67021 67030, 67031
Allen, De Kalb, Huntington, Lagrange, Noble, Whitley
AARP® Medicare Advantage Focus (PPO) Lutheran
H2228-020 67007, 74000 67032, 74001
Adams, Allen, Huntington, Wells, Whitley
AARP® Medicare Advantage Choice Plan 1 (PPO)
H2228-021 67025, 67024 67194, 67195 67026, 67027 67028, 67029
Bartholomew, Benton, Blackford, Boone, Brown, Carroll, Clinton, Decatur, Delaware, Fayette, Fountain, Hamilton, Hancock, Hendricks, Henry, Howard, Johnson, Lawrence, Madison, Marion, Monroe, Montgomery, Morgan, Orange, Putnam, Randolph, Rush, Shelby, Tippecanoe, Tipton, Union, Warren, White
AARP® Medicare Advantage Choice (PPO)
H2228-022 67017, 67034 Crawford, Daviess, Dubois, Gibson, Knox, Martin, Perry, Pike, Posey, Spencer, Vanderburgh, Warrick
AARP® Medicare Advantage Choice (PPO)
H2228-064 67171, 67172 90101, 90102
Jasper, La Porte, Lake, Newton, Porter, Pulaski, Starke
AARP® Medicare Advantage Choice (PPO) H2228-065
67173, 67174 90103, 90104
Clark, Dearborn, Floyd, Franklin, Harrison, Jackson, Jefferson, Jennings, Ohio, Ripley, Scott, Switzerland, Washington
AARP® Medicare Advantage Choice (PPO)
H2228-066 67175, 67176 90105, 90106
Clay, Greene, Owen, Parke, Sullivan, Vermillion, Vigo
AARP® Medicare Advantage Choice Plan 2 (PPO)
H2228-080 74055,90126 Adams, Allen, De Kalb, Elkhart, Huntington, St. Joseph, Wells, Whitley
AARP® Medicare Advantage Choice Plan 2 (PPO)
H2228-081 74056, 74057 90127, 90128
Boone, Hancock, Hamilton, Hendricks, Johnson, Marion
© 2020 United HealthCare Services, Inc. All rights reserved. PCA-1-20-00217-M&R-PRES_01222020
Indiana Plan Specifics
14 © 2020 United HealthCare Services, Inc. All rights reserved. PCA-1-20-00217-M&R-PRES_01222020
Indiana Plan Specifics
15 © 2020 United HealthCare Services, Inc. All rights reserved. PCA-1-20-00217-M&R-PRES_01222020
Indiana Plan Specifics
16 © 2020 United HealthCare Services, Inc. All rights reserved. PCA-1-20-00217-M&R-PRES_01222020
Indiana Plan Specifics
17 © 2020 United HealthCare Services, Inc. All rights reserved. PCA-1-20-00217-M&R-PRES_01222020
Indiana Plan Specifics
18 © 2020 United HealthCare Services, Inc. All rights reserved. PCA-1-20-00217-M&R-PRES_01222020
Indiana Plan Specifics
19 © 2020 United HealthCare Services, Inc. All rights reserved. PCA-1-20-00217-M&R-PRES_01222020
Indiana Plan Specifics
20 © 2020 United HealthCare Services, Inc. All rights reserved. PCA-1-20-00217-M&R-PRES_01222020
Indiana Plan Specifics
21 © 2020 United HealthCare Services, Inc. All rights reserved. PCA-1-20-00217-M&R-PRES_01222020
Indiana Plan Specifics
22 © 2020 United HealthCare Services, Inc. All rights reserved. PCA-1-20-00217-M&R-PRES_01222020
Indiana Plan Specifics
23 © 2020 United HealthCare Services, Inc. All rights reserved. PCA-1-20-00217-M&R-PRES_01222020
Recognizing Our Plans
UnitedHealthcare Medicare Advantage ID Cards
Plan Name Type
PCP Name and Phone Number
Copay Information
HMO – POS
Sample member ID cards for illustration only. Actual information varies depending on payer, plan and other requirements.
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Medicare Contract Number
PPO
© 2020 United HealthCare Services, Inc. All rights reserved. PCA-1-20-00217-M&R-PRES_01222020
UnitedHealthcare Medicare Advantage ID Cards
WellMed
Sample member ID cards for illustration only. Actual information varies depending on payer, plan and other requirements.
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National PPO
© 2020 United HealthCare Services, Inc. All rights reserved. PCA-1-20-00217-M&R-PRES_01222020
UnitedHealthcare Medicare Advantage ID Cards
DSNP
Sample member ID cards for illustration only. Actual information varies depending on payer, plan and other requirements.
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Members no longer need to activate Passport to access care outside their local service area for PPO plans. Activation is needed for HMO plans only.
© 2020 United HealthCare Services, Inc. All rights reserved. PCA-1-20-00217-M&R-PRES_01222020
Doing Business with Us
Claims Submission
Electronic Submission
Payer ID 87726*
• You can submit claims using the claimsLink tool on Link.
• You can also use the clearinghouse of your choice.
• If you receive an 835 Electronic Remittance Advice (ERA) through a vendor, please ask them to enroll you for the 835 through OptumInsight.
• To find out more, please contact your vendor or call Electronic Data Interchange (EDI) at 800-842-1109.
• For WellMed Payer ID, WELM2, reference member ID card for details.
Paper Submission Mail Claims to:
Address outlined on the back of each member’s ID card.
Standard Timely Filing: • 90 days from the date of service or the time
frame in your participation agreement.
Claim Resubmission
• Preferred Method: Submit electronically through your EDI clearinghouse or use the claimsLink tool on Link.
• When resubmitting through claimsLink, choose “Resubmission of a correct claim.”
• You can include attachments, such as invoices.
• You’ll receive a confirmation number – save this number for future reference.
29 © 2020 United HealthCare Services, Inc. All rights reserved. PCA-1-20-00217-M&R-PRES_01222020
Signing Up for Electronic Payments & Statements
With Electronic Payments & Statements (EPS), you receive electronic funds transfers (EFT) for claim payments and an online Explanation of Benefits (EOBs).
• EPS lessens administrative costs and simplifies bookkeeping.
• Reimbursement turnaround time is faster.
• Funds are available as soon as they are posted to your bank account.
To enroll in EPS today, visit myservices.optumhealthpaymentservices.com.
Here’s what you’ll need:
• Bank account information for direct deposit
• Either a voided check or a bank letter to verify bank account information
• A copy of your practice’s W-9 form
For more information, please call 877-620-6194.
UHCprovider.com/eps
30 © 2020 United HealthCare Services, Inc. All rights reserved. PCA-1-20-00217-M&R-PRES_01222020
Online Resources: UHCprovider.com
Resources specifically for Medicare Advantage plans can be found at UHCprovider.com/plans > Choose Your State > Medicare.
Register at UHCprovider.com/newuser to use Link, your gateway to
UnitedHealthcare’s online tools.
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Find administrative guides, policies and protocols.
Access the most- used transactions and information.
© 2020 United HealthCare Services, Inc. All rights reserved. PCA-1-20-00217-M&R-PRES_01222020
eligibilityLink: Benefits and eligibility information
claimsLink: Claim status and payment determination/remediation
Electronic Payments and Statements: Receive EFTs for claim payments and an online EOB
Document Vault: Contains commercial claim letters
Paperless Delivery Options: Turn off paper letters
Prior Authorization and Notification: Prior authorization determination and submission
PreCheck MyScript: Run a pharmacy trial claim and get real-time prescription coverage details for your patients
Access Link through UHCprovider.com/link. If you have questions, please call the UnitedHealthcare Connectivity Help Desk at 866-842-3278, option 1, 7 a.m. to 9 p.m. Central Time, Monday through Friday.
Online Resources: Link
32 © 2020 United HealthCare Services, Inc. All rights reserved. PCA-1-20-00217-M&R-PRES_01222020
How We Communicate with You
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• UHCprovider.com has a variety of resources that include:
- Care Provider Administrative Guide at UHCprovider.com/guides
- Practice Matters newsletter
- Network Bulletin newsletter
- Provider alerts and reimbursement policy updates
- Medicare Advantage plan summaries by state
© 2020 United HealthCare Services, Inc. All rights reserved. PCA-1-20-00217-M&R-PRES_01222020
Indiana Provider Advocates and Network Management
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• Your Provider Advocate is an important resource when you have questions. They are your single point of contact across all UnitedHealthcare’s benefit plans to help make your interactions with us easier and more efficient.
• If you have questions, please contact your Provider Advocate at [email protected] or
Network Management at [email protected].
• If you don’t know your dedicated Provider Advocate, please contact Provider Relations at
UHCprovider.com > Menu > Contact Us > Find a Network Contact > Indiana.
© 2020 United HealthCare Services, Inc. All rights reserved. PCA-1-20-00217-M&R-PRES_01222020
Thank you.
Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a Medicare-approved Part D sponsor. Enrollment in these plans depends on the plan's contract renewal with Medicare. UnitedHealthcare Insurance Company pays royalty fees to AARP® for the use of its intellectual property. These fees are used for the general purposes of AARP.® AARP® and its affiliates are not insurers. You do not need to be an AARP® member to enroll. AARP® encourages you to consider your needs when selecting products and does not make specific product recommendations for individuals. PCA-1-20-00217-M&R-PRES_01222020 © 2020 United HealthCare Services, Inc.