Laserfiche WebLink
F. MEMBER SERVICES <br />Com <br />Toll -free access to a customer care unit using a dedicated <br />number <br />. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .................................. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . . . . . . . . . . . . . . .................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br />Employee access to a member website enabling Participants <br />to: <br />• Check claim status. <br />• Check eligibility information. <br />• Search for providers and online health information. <br />G. MEDICARE SERVICES <br />Service Comments <br />Medicare Secondary Payer Reporting. United shall <br />provide to applicable parties the applicable reports in a time <br />and manner as required according to the Medicare Secondary <br />Payer Mandatory Reporting Provisions (the Reporting <br />Requirements) in Section 111 of the Medicare, Medicaid and <br />SCRIP Extension Act of 2007. United shall not be <br />responsible for any noncompliance penalties in connection <br />with the Reporting Requirements that are related to the <br />Customer's failure to provide the required data. <br />H. NETWORK SERVICES <br />Network access, management and administrative activities <br />..................................................................... .... ..... <br />UnitedHealth Premiums" Designation Program 11 <br />Network access to chiropractic and complementary <br />alternative medicine providers <br />. . . . . . . . . . . . . . . . . . . . . . . . ..................... . . . . . . . . . . . . . . . . . . . . . . . .......................................... . <br />Transplant Solutions (TS) Services <br />• Transplant Network via Centers of Excellence (COE) <br />• Transplant Access Program (TAP) Network <br />• Extra - Contractual Services - contracting on a case -by <br />case basis for transplant care outside of the COE or TAP <br />tworks for a stanard neotiatn fee. <br />........... I ............................................................... ............ ................................. ­­.­ ......................................... - ...................................... <br />Reasonable and customary charge guidelines for out of <br />network surgical, medical, lab and x -ray claims. <br />Maximum Non - Network Reimbursement Program <br />(MNRP) for non - emergency non - network claims. <br />. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ............... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br />Shared Savings Program <br />Application of the Shared Savings Program provides <br />additional savings on select non - Network facility and <br />physician claims not eligible for standard network discounts. <br />Program provides access to discounted charges made <br />available to United from health care providers who contract <br />or will negotiate with, a third party to provide such <br />discounted charges. <br />Access to Extended Networks <br />Customer agrees to provide to United in a timely manner and <br />in an agreed upon format any and all data that United requires <br />to comply with the Reporting Requirements. <br />Standard on all network Plans. <br />Available in designated markets. <br />The services under this program provide access to provider <br />discounts only and do not include credentialing of providers or <br />other Network services. United is not responsible for the <br />medical outcomes or the quality or competence of any provider <br />or facility rendering services under the Shared Savings <br />Program. <br />United can terminate the Shared Savings Program at any time <br />for an reason. <br />.................. . . . . y . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ............................................ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br />Available at an additional charge. <br />I. CARE MANAGEMENT AND OUTREACH SERVICES <br />Service Comments <br />Care CoordinationsM, focuses on offering education, <br />accelerating access to care and providing surveillance and <br />monitoring of chronic conditions. <br />Services include the review of Participants' diagnosis and <br />proposed health care treatments with respect to whether or <br />not the service is appropriate to treat the condition. The <br />services are designed to facilitate Participant education, <br />21 <br />