Physician Reimbursement and Resources Under the UnitedHealthcare Dual Complete® Plan September 8, 2022

Content provided by UnitedHealthcare Community & State District of Columbia

UnitedHealthcare will reimburse you according to the existing Medicare contracted rates for eligible and covered services. In addition, we will process necessary Medicare cost-share portions in line with Department of Health Care Finance (DHCF) cross over logic. Depending on the enrollee’s eligibility for Medicaid, we may be responsible for the management and payment of Medicaid benefits. Those Medicaid covered services will be reimbursed according to your existing Medicaid contracted rates. This means UnitedHealthcare is crossing over and processing the eligible Medicaid-covered services according to the enrollee’s benefits. You will not be required to submit a secondary claim to the Medicaid payer in this situation. At times, you may receive 2 provider remittance advices (PRAs) for services covered by both Medicare and Medicaid.

Health care professionals may not attempt to collect additional reimbursement from Medicare enrollees whose Medicaid benefits cover all Medicare cost-sharing components. These enrollees are not responsible for Medicare cost sharing under CMS regulations. Medicare cost sharing includes the deductibles, coinsurance and copays included as part of Medicare benefit plans.

Health care professional resources

• To learn more about this plan, visit UHCprovider.com/DC
• If you have questions, please call Provider Services at 1-888-350-5608 and select “Health Care Provider”
  

The UnitedHealthcare Community Plan care provider education and training program includes the following care provider components:

• Website
• Forums/town hall meetings
• Newsletters and bulletins
• Manual

Provider Advocates:

Provider advocates visit PCPs and specialist offices as needed. We do this to create program awareness, promote compliance, and resolve problems

If you don’t know who your provider advocate is, email northeastprteam@uhc.com. A provider advocate will get back to you.