The covering provider must also be a participating provider. Participating providers agree that healthcare will be available from the provider, or from a covering provider, twenty-four hours a day, seven days a week. In regards to U of U Health Plans Individual and Family plans, Healthy U Medicaid, Healthy U Behavioral, and Advantage U (Medicare POS) members, comply with all state and federal regulations.Refer members to participating providers for extended services (e.g., laboratory, consultations, imaging).Abide by the contracted U of U Health Plans network(s) grievance and appeal procedures.Hold member harmless for any billed charges in excess of the contracted fee schedule allowed amounts.Hold members harmless for any charges in excess of deductible, copayment, or coinsurance amounts specified by their U of U Health Plans benefit plan. Bill U of U Health Plans directly for covered services.Freely communicate with patients about their treatment options, regardless of benefit coverage limitations.Inform members of covered services as well as other programs and resources available to them for prevention, education, and treatment.Deliver covered services and supplies in accordance with the U of U Health Plans benefit plans.Prior Authorizations (CVS Caremark ) Phone: Other diagnoses are considered nonroutine.Ĭlaim Inquiries, Customer Service, Eligibility for members Note: Only providers contracted with TruHearing may offer or bill audiology services with a routine diagnosis. Paper Claims with Nonroutine Audiology Diagnoses for Advantage U Advantage U Signature and Advantage U Signature Part B Buyback members: Paper Claims with Routine Vision Services for Advantage U Advantage U Signature and Advantage U Signature Part B Buyback members: Paper Medical Claims for Advantage U Signature and Advantage U Signature Part B Buyback members: We welcome your suggestions on how we can better serve you and your staff.įor us, this is more than insurance, this is personal.ĮDI Trading Partner Number for all U of U Health Plans and Advantage U:Īll Paper Claims for Commercial, Individual and Family, or Healthy U Medicaid members: Our goal is not to just operate at industry standards, but to exceed them in every possible way. We also function as a third-party benefit and/or claims administrator for other payers, behavioral health programs, and select collaborations within the University of Utah. We specialize in health plan administration of physical and mental health and pharmacy benefits for fully insured and self-funded employers groups, individuals and families, Medicare Advantage and Medicaid beneficiaries. U of U Health Plans offers a full suite of products providing health insurance coverage and services to plan members in Utah and the greater Mountain West. Since our inception, we have been recognized as a reliable, innovative health insurance plan committed to enhancing the member experience, improving the quality of care, strengthening the health of populations, and reducing the cost of care. U of U Health Plans was organized in 1998 with the formation of Healthy U Medicaid, a Medicaid Managed Care plan. We are proud to be your community partner and we value and honor the distinctive connection that you share with us and our members. We are committed to enhancing the member experience, improving the quality of care, strengthening the health of populations, and reducing the cost of care. Welcome to University of Utah Heath Plans (U of U Health Plans).
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