KanCare Training for Providers - Ubhonline.com

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Provider Responsibilities • Check member’s eligibility prior to performing services by phone or online at uhccommunityplan.com • Refer to in-network providers, directory available at liveandworkwell.com • Adhere to the authorization policies as outlined in the provider manual • Adhere to appointment and accessibility standards as outlined in the provider manual • Adhere to medical record keeping and chart review standards • Provide services consistent with professional and ethical standards as set forth by national certification and state licensing boards, and applicable law or regulation regardless of a member’s Benefit Plan or terms of coverage Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 36
Provider Responsibilities • Provide services to members in a non-discriminatory manner • Determine if members have medical benefits through other insurance coverage • Advocate for members as needed • Notify us at providerexpress.com within ten (10) calendar days whenever you make changes to your office location, billing address, phone number, Tax ID number, entity name, or active status (e.g., close your business or retire) This includes roster management. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 37
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 and 26: Billing and Claims
Page 27 and 28: Claims Tips To ensure clean 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: Access to Care - Standards Routine
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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