KanCare Training for Providers - Ubhonline.com

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Claims Submission Required Claim Forms CMS-1500 form Inpatient Hospital providers, use UB-04 Claims/Customer Service # : 855-802-7095 Electronic Claims Payer ID: 96385 Paper Claims: When submitting behavioral Claims by paper, please mail claims to: KMAP P.O. Box 3571 Topeka, KS 66601-3571 Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 26
Claims Tips To ensure clean claims remember: • An NPI # is always required on all claims • A complete diagnosis is also required on all claims Claims filing deadline • Example: 295 Schizophrenic disorders is an incomplete diagnosis code as 5 digits are required • Providers should refer to their contract with Optum to identify the timely filing deadline that applies. Claims Processing Balance Billing • Clean claims, including adjustments, will be adjudicated within 30 days of receipt. • The member cannot be balance billed for behavioral services covered under the contractual agreement. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 27
Page 1 and 2: KanCare Training for Providers Optu
Page 3 and 4: Introduction to Optum • United Be
Page 5 and 6: Behavioral Health Services
Page 7 and 8: Behavioral Services • Inpatient H
Page 9 and 10: Value Added Services - continued
Page 11 and 12: Pre-Specified Initial Authorization
Page 13 and 14: Authorization Non-emergent situatio
Page 15 and 16: Eligibility and Benefit Review Proc
Page 17 and 18: Appeals and Grievances
Page 19 and 20: Services While In Appeal • You ma
Page 21 and 22: Treatment Record Documentation
Page 23 and 24: Discharge Planning • Effective di
Page 25: Billing and Claims
Page 29 and 30: Member Information
Page 31 and 32: Member Rights and Responsibilities
Page 33 and 34: Provider and Member Resources An ex
Page 35 and 36: Access to Care - Standards Routine
Page 37 and 38: Provider Responsibilities • Provi
Page 39 and 40: Optum Provider Website • Provider
Page 41 and 42: Network Participation
Page 43 and 44: Joining Our Network If you have rec

KanCare Training for Providers - Ubhonline.com

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