![]() ![]() Mail paper CMS 1500 or UB-04s to the address listed on the member’s ID card. To avoid processing delays, you must validate with your clearinghouse for the appropriate Payer ID number or refer to your clearinghouse published Payer Lists. In some cases, the Payer ID listed on /edi may be different from the numbers issued by your clearinghouse. For a complete list of Payer IDs, refer to the Payer List for Claims. Submit your claims and encounters and primary and secondary claims as EDI transaction 837.įor UnitedHealthcare West encounters, the Payer ID is 95958. OptumInsight Connectivity Solutions, UnitedHealthcare’s managed gateway, is also available to help you begin submitting and receiving electronic transactions. For information on EDI claim submission methods and connections, go to EDI 837: Electronic Claims. Refer to our online Companion Guides for the data elements required for these transactions found on /edi. Resubmit claims in the UnitedHealthcare Provider Portal at > Sign In > Claims & Payments. Submit all professional and institutional claims and/or encounters electronically for UnitedHealthcare West and Medicare Advantage HMO product lines.ĭo not resubmit claims that were either denied or pended for additional information using EDI or paper claims forms. Health insurance plans contain exclusions and limitations.EDI is the preferred method of claim submission for participating physicians and health care providers. Provider participation may change without notice. Providers are independent contractors and are not agents of Banner|Aetna. An application must be completed to obtain coverage. 98point6 is available to members age 1-17 when an adult parent or guardian is also enrolled in the plan. ![]() Access to 98point6 ® is not included in all plans. Aetna and Banner Health provide certain management services to Banner|Aetna. Aetna, CVS Pharmacy ® and MinuteClinic, LLC (which either operates or provides certain management support services to MinuteClinic-branded walk-in clinics) are part of the CVS Health ® family of companies.ĩ8point6 ® is a registered trademark of 98point6 Inc. Each insurer has sole financial responsibility for its own products. Banner|Aetna is an affiliate of Banner Health and of Aetna Life Insurance Company and its affiliates (Aetna). Health benefits and health insurance plans are offered, underwritten, and/or administered by Banner Health and Aetna Health Insurance Company and/or Banner Health and Aetna Health Plan Inc. It gets the providers focused on really being close to the patients and understanding what the patient's needs are and taking ownership of that.Īs an owner of Banner|Aetna, Banner Health passes along preferred unit costs for Banner|Aetna, which enables us to drive greater savings for our plan sponsors and their members. So, Banner Health Network and our team is responsible for prior authorization, case management, Multi-Disciplinary Care Team. We've transferred much of the responsibility for the care delivery model to the provider. And it enables us to bring more affordable, more connected plans to our members. We are aligned with the largest health system here in Arizona with the goal of transforming the way we deliver care. We're financially aligned to figure out ways to improve the quality and the efficiency of the care to our members. We're in a joint venture, which is the most advanced form of value-based care. We found out that, "Hmm … this is working pretty good.” Maybe we should be equity partners and we should really be building the long-term value of this. We saw some improvement in our performance. We started to see some good, shared savings.
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