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UnitedHealthcareCommunity Plan of IndianaHoosier Care Connect Health PlanClaims 101Presented by Jodie Hattery, Vice President, Provider Market Operations 2020 United HealthCare Services, Inc. All rights reserved.

Agenda Medical/Behavioral Health- How to file a claim- How to dispute a claim- How to file a reconsiderationa)Via UnitedHealthcare Provider Portalb)Via paper form- How to dispute the reconsideration decision- How to appeal the dispute decision- When to escalate to the Provider Advocate Team Vision- How to file a claim- How to dispute a claim Dental- How to file a claim- How to dispute a claim 2020 United HealthCare Services, Inc. All rights reserved.2

Our Service Lines UnitedHealthcare Optum Behavioral Health March Vision UnitedHealthcare Dental 2020 United HealthCare Services, Inc. All rights reserved.3

UnitedHealthare Medical&Optum Behavioral HealthClaims

MEDICAL &BEHAVIORAL Submit CMS 1500 Claim Form or UB04 form, whichever is appropriate. Standard Timely Filing for ParProviders - 90 days from the date ofservice (DOS). Non-Contracted Providers TimelyFiling – 180 days from DOS. For electronic submission:Payer ID 87726 Claims Mailing Address:UnitedHealthcare Community PlanP.O. BOX 5240Kingston, NY 12402 Claim Submission Tool for MedicalProfessional claims (CMS 1500) on ourUnitedHealthcare Provider Portal (formerlyLink) Newborn Claims Timely Filing – 180days from DOS. Secondary Claims Timely Filing – 90days from date of Primary EOB for INNProviders & 180 for OON providers fromthe Primary EOB date. 2020 United HealthCare Services, Inc. All rights reserved. Behavioral Health Professional claims(CMS 1500) on our Provider ExpressIndiana Portal Click claim entry5

MEDICALClaims andEligibility Check claim status. Check member eligibility status. Start a claim reconsideration orappeal once claim has beenlocated. Obtain electronic image of amember’s Hoosier Care ConnectInsurance Card. 2020 United HealthCare Services, Inc. All rights reserved.6

MEDICALWhen Should YouSubmit a ClaimsReconsideration?You should submit a claims reconsideration requestthrough the Claims tool when you believe a claim waspaid incorrectly. Situations for reprocessing include, butare not limited to: Amount is different than what provider expected Claim was filed in a timely manner, but denied fortimely filing Claim was denied for no authorization, when providerhas an authorization number Difference in Coordination of Benefits (COB)information 2020 United HealthCare Services, Inc. All rights reserved.7

MEDICALHow do I Submit aClaimsReconsiderationwithin the ClaimsTool?Click Create ClaimReconsideration to start yourreconsideration request or submit acorrected claim.Providers have 90 days from theoriginal EOB date to submit a ClaimReconsideration. 2020 United HealthCare Services, Inc. All rights reserved.Need a paper form because you are unable to submit yourreconsideration online? Use our Single Paper ClaimReconsideration Request Form found at the link below and mailto the claims mailing econsiderationForm.pdf8

MEDICAL Scroll down to review the details. Enter your contact information inthe Submitter's Contact Informationsection. Once Submitted, document the“Ticket” number received. 2020 United HealthCare Services, Inc. All rights reserved.9

BEHAVIORALHow do I Submit aClaimsReconsideration?Securely login to Provider Express Claim Inquiry Search for claim Click “Enter” under claim adjustmentProviders have 90 days from theoriginal EOB date to submit a ClaimReconsideration. 2020 United HealthCare Services, Inc. All rights reserved.10

2020 United HealthCare Services, Inc. All rights reserved.11

BEHAVIORAL Select a reason from thedropdown. Select “Review.” Review details and add necessarycomments on next screenexplaining why a reconsideration isbeing requested. Select “Submit.” Once Submitted, document the“Confirmation Number” and “IssueID.” 2020 United HealthCare Services, Inc. All rights reserved.12

MEDICAL &BEHAVIORALWhat if I don’tagree with theoutcome of myClaimReconsideration? 2020 United HealthCare Services, Inc. All rights reserved. Per the Administration Guide, Par Providers mustadhere to the following filing limits from the date of theoriginal processing/denial date to dispute a claim:1) Reconsideration – 90 Days from original denial1.5) Send to Advocate or SNF Claims Teams2) Formal Dispute – 60 Days from reconsideration3) Formal Provider Grievance – 120 Days from thefailed Dispute (must include additional or newinformation)13

MEDICAL &BEHAVIORALWhat if I don’tagree with theoutcome of myClaimReconsideration?MEDICAL ADVOCATE TEAM If you are a health system or provider with a dedicatedClaims/Internal Advocate, please email to thatdedicated Advocate. If you do not have a dedicated Claims/InternalAdvocate, utilize the claims template and email to:centralprteam@uhc.com. If you need the claims template and instructions, youcan request those from the Central PR Team via emailat centralprteam@uhc.com .SKILLED NURSING FACILITY CLAIMS TEAM Send unresolved SNF claims to:snfprteam@optum.com. 2020 United HealthCare Services, Inc. All rights reserved.14

MEDICAL &BEHAVIORALWhat is the nextstep in the DisputeProcess? If you still disagree with the outcome of yourclaim after the Advocate team has escalated,your next step is to file a formal dispute. Must be submitted within 60 days from thefailed reconsideration Mail to: UnitedHealthcare Community Plan of Indiana,Attn: Appeals and Grievances UnitPO Box 31364Salt Lake City, UT 84131-0364 Submit within the Claims Tool on ourUnitedHealthcare Provider Portal 2020 United HealthCare Services, Inc. All rights reserved.15

MEDICAL &BEHAVIORALWhat if I stilldisagree? If you still disagree with the outcome of your formaldispute, you may file a Formal Provider Grievance. Formal Provider Grievance must be submittedwithin 120 days from the failed Formal Dispute(Must include additional or new information). Mail to: UnitedHealthcare Community Plan of IndianaAttn: Appeals and Grievances UnitPO Box 31364Salt Lake City, UT 84131-0364 Submit within Claims on our UnitedHealthcareProvider Portal for medical claims or ProviderExpress Indiana for BH claims 2020 United HealthCare Services, Inc. All rights reserved.16

MEDICALAdministrativeProviderResources Education resources for submitting claims isavailable on our provider website. Claim system configuration follows Federaland Indiana Medicaid claims billing guidelines. Accept paper or electronic claim submissions. Link to file professional claims with UnitedHealthcare UHCprovider.com/claims 2020 United HealthCare Services, Inc. All rights reserved.17

March Vision Claims

VISIONHow to fileMarch Vision Careclaims Online provider portal: eyeSynergy.com Use our convenient online providerportal: eyeSynergy.com. For electronic submission: Submit claims electronically or viapaper claim using the standard1500Claim Form. Claims Mailing Address: Standard Timely Filing forParticipating Providers - 90 days fromthe date of service (DOS).Payer ID 52461MARCH Vision Care6601 Center Drive West, Suite 200Los Angeles, CA 90045 Non-Contracted Providers TimelyFiling - 90 days from DOS. 2020 United HealthCare Services, Inc. All rights reserved.19

VISIONHow do I Submit aClaimReconsideration?Providers have 60 days from theoriginal EOB date to submit a ClaimReconsideration.You can also use our online form to submitelectronically from the following link:https://forms.marchvisioncare.com/Forms/PDR 2020 United HealthCare Services, Inc. All rights reserved.20

UnitedHealthcare Dental Claims

DENTALHow to file Dentalclaims Timely filing All claims, including secondaryclaims, should be submittedwithin 90 days from the date ofservice for participatingproviders or within 180 daysfrom the date of service fornon-contracted (Out ofNetwork) providers. Electronic Claims Electronic claims processing requires access to a computerand usually the use of practice management software. Electronically generated claims can be submitted through aclearinghouse or directly to our claims processing system viathe internet. UnitedHealthcare Community Plan partners with electronicclearinghouses to support electronic claims submissions. If you wish to submit claims electronically, contact yourclearinghouse to initiate this process. While the payer ID may vary for some plans, the Payer ID forCommunity Plan members is GP133. Please refer to the Important Addresses and Phone Numberssection for additional information as needed. Electronic submission is secure as the information beingtransmitted is encrypted. Call 1--877-897-4941 for more information regardingelectronic claims submission. 2020 United HealthCare Services, Inc. All rights reserved.22

DENTALHow to file Dentalclaims 2020 United HealthCare Services, Inc. All rights reserved. HIPAA-Compliant 837D file The 837D is a HIPAA-compliant EDItransaction format for the submissionof dental claims. This transaction set can be used tosubmit health care claim billinginformation, encounter information orboth, from providers of health careservices to payers via establishedclaims clearinghouses.23

DENTALHow to file Dentalclaims Paper claims UnitedHealthcare Dental Claims Paper Claims Refer to the Quick Reference Guidefor addresses and phone numberinformation. 100% of all clean paper claims will bepaid or denied within 30 days ofreceipt. 100% of all clean electronic claims willbe paid or denied within 21 calendardays of receipt. 2020 United HealthCare Services, Inc. All rights reserved.PO Box 781Milwaukee, WI 53201 Paper claims must be submitted on an American DentalAssociation (ADA) Dental Claim Form (2012 version or later). Claims filed on incorrect forms will be returned. Claims must be legible. Computer-generated forms are recommended. Additional documentation and radiographs should beattached, when applicable. (Such attachments arerequired for pre-treatment estimates and for thesubmission of claims for complex clinical procedures).24

DENTALHow to file DentalCorrected Claims 2020 United HealthCare Services, Inc. All rights reserved. Corrected claim process Providers who receive a claim denial andneed to submit a corrected claim shouldsubmit a corrected claim and appropriatedocumentation, if necessary, to: Corrected ClaimsP.O. Box 481Milwaukee, WI 53201 The determination of a corrected claimrequest will be provided via a remittancestatement within 30 days of receipt.25

DENTALHow do I dispute howa dental claim wasprocessed/denied?Informal Objections and Formal AppealsPO Box 1391Milwaukee, WI 53201 Appealing a denied claim payment Providers have the right to appeal a claim paymentthat is fully or partially denied. UnitedHealthcare willfollow state and Federal guidelines in themanagement of the appeals process, including 405Indiana Administrative Code (IAC) 1-1.6. Providers may submit an Informal Objection within60 days of the adverse claim determination ("claimdenial"). This Informal Objection must be submittedin writing at the address below. The InformalObjection will be reviewed and resolved within 30days. If providers are not satisfied with the resolution to theInformal Objection, providers may submit a FormalAppeal in writing within 60 days of the InformalObjection to the same address below. The FormalAppeal will be reviewed and resolved within 30 days. 2020 United HealthCare Services, Inc. All rights reserved.26

DENTALTips for successfulDental claimresolution Do not let claim issues grow or go unresolved. Call Provider Services if you can’t verify a claim ison file. Do not resubmit validated claims on file unlesssubmitting a corrected claim with the requiredindicators. File adjustment requests and claims disputeswithin contractual time requirements. If you must exceed the maximum daily frequencyfor a procedure, submit the medical recordsjustifying medical necessity. If you have questions,call Dental Provider Services. 2020 United HealthCare Services, Inc. All rights reserved.27