Health Choice Utah Medicaid Providers

Date:

Health Choice Generations Account Holders

Utah Medicaid Statewide Provider Training

In an ongoing effort to improve Health Choice Generations on-line web-based services, we have designed and built a brand new single sign on secure Provider Portal that allows access to both our Medicare and Medicaid lines of business.

Currently registered Health Choice Utah Account Holders will not need to re-register to use the new system for Health Choice Generations Utah HMO SNP however, providers that were also account holders on our Medicaid website will need to follow the on screen prompts within the Provider Portal to initially register to view our Medicare information.

We hope that you enjoy the improvements we have made to our on-line services, and invite your comments and feedback.

Members Providers Or Appointed Representatives

You can request a Pharmacy Coverage Determination or exception online by visiting our Prior Authorization/Pre-Certification Portal | 2022 Provider Directory

Note: Pharmacy prior authorization ONLY. Medical prior authorization requests may be submitted via the Provider Portal.

To See which Medical Services require PA, see Services Requiring Prior Authorization

What We Offer Our Physician Network

Health Choice Utah brings the expertise and road maps necessary to understand, participate in and maximize the value of the sweeping changes affecting the delivery of healthcare.

We offer real-time tools, technology and up-to-date information to our physicians and providers. We will assist and offer guidance to physicians and hospitals for the purpose of building partnerships in the form of Accountable Care Organizations , patient-centered medical homes and other entities that will maximize quality and reward performance.

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American Health Advantage Of Utah

Revere Health providers participate on American Health Advantage, which is an Institutional Special Needs Plan contracted with Medicare. The plan is specially designed for eligible Medicare beneficiaries living in a long-term care nursing home. Currently, American Health Advantage is covering residents of long-term nursing homes in Box Elder, Salt Lake, Utah and Weber counties.

How To Request An Exception

Administration
  • You can ask us to cover your drug even if it is not on our formulary.
  • You can ask us to waive coverage restrictions or limits on your drug.
  • You can ask us to provide a higher level of coverage for your drug.
  • You should contact us to ask us for an initial coverage decision for a formulary, tiering or utilization restriction exception. When you are requesting a formulary, tiering or utilization restriction exception you should submit a statement from your physician supporting your request. Generally, we must make our decision within 72 hours of getting your prescribing physicians supporting statement. You can request an expedited exception if you or your doctor believe that your health could be seriously harmed by waiting up to 72 hours for a decision. If your request to expedite is granted, we must give you a decision no later than 72 hours after we get your prescribing physicians supporting statement.

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    Specialty Drug

    Preventative

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    Unitedhealthcare Connected General Benefit Disclaimer

    This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook. Limitations, copays and restrictions may apply. For more information, call UnitedHealthcare Connected® Member Services or read the UnitedHealthcare Connected® Member Handbook. Benefits, List of Covered Drugs, pharmacy and provider networks and/or copayments may change from time to time throughout the year and on January 1 of each year.

    You can get this document for free in other formats, such as large print, braille, or audio. Call Member Services, 8 a.m. – 8 p.m., local time, Monday – Friday . The call is free.

    You can call Member Services and ask us to make a note in our system that you would like materials in Spanish, large print, braille, or audio now and in the future.

    Language Line is available for all in-network providers.

    Puede obtener este documento de forma gratuita en otros formatos, como letra de imprenta grande, braille o audio. Llame al Servicios para los miembros, de 08:00 a. m. a 08:00 p. m., hora local, de lunes a viernes correo de voz disponible las 24 horas del día,/los 7 días de la semana). La llamada es gratuita.

    Puede llamar a Servicios para Miembros y pedirnos que registremos en nuestro sistema que le gustaría recibir documentos en español, en letra de imprenta grande, braille o audio, ahora y en el futuro.

    How To Get Both Medicare And Medicaid In Utah

    If you are eligible for Medicaid in Utah but also meet the qualifications for Medicare, you can benefit from both programs! You can qualify for Medicare by turning 65, by having ALS or ESRD, or by receiving disability benefits for at least 24 months.

    If you do qualify for both programs, you can enroll in a Medicare Advantage Dual Special Needs Plan . A DSNP can cover most or all of your health services at very little or no cost to you. DSNPs are unique to people who qualify for both Medicare and Medicaid and can be the cheapest way for you to get the coverage you need. However, there are hundreds of these plans available. For help finding the best plan in your county, speak with one of our licensed agents by calling 833-438-3676 or sending us a message.

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    What Is A Formulary

    A formulary is a list of covered drugs which represents the prescription therapies believed to be a necessary part of a quality treatment program. We will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a network pharmacy, and other plan rules are followed. For more information on how to fill your prescriptions, please review your Evidence of Coverage.

    How We Assist Your Practice

    Medicare Help in Utah from a Local UnitedHealthcare Agent

    We are committed to providing you with tools to help you effectively and efficiently manage the care of the individuals you serve through Health Choice Utah.

    Our medical director, Dr. Richard Ferguson, MD. , is not just an administrator. Dr. Ferguson is a practicing physician who has been in Utah for over many years. He understands the concerns and issues you face daily.

    We work closely with your team to streamline and expedite prior authorization by minimizing the number of procedures requiring prior authorization. Many of the items still on our abbreviated prior authorization list ask for notification only.

    Our Transition of Care Program is unique to the industry. Upon hospital discharge, we initiate an interdisciplinary plan of care which can include assessment of home care needs, follow-up with home care providers, medication reconciliation, scheduling and transition to case management and disease management.

    Customer service is the fabric of our organization. Our internal infrastructure is designed to provide your patients speedy access to customer service representatives and to expedite claims processing.

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    At Health Choice Utah We Are Committed To A Collaborative Approach With Physicians Hospitals And All Other Providers In All Communities Throughout The State Of Utah

    We believe our members deserve the highest quality medical care while being treated with both compassion and respect. Assisting you so that you can devote your time to providing quality patient care is one of our highest priorities. Our commitment to you is to support the doctor-patient relationship by streamlining the delivery of care.

    Welcome To Health Choice Generations Utah Hmo Snp Provider Portal

    The Health Choice Generations Provider Portal has been designed with you in mind. Our goal for the site is twofold.

    We want to assist you with reducing administrative burdens by streamlining processes and providing a one-stop-resource shop saving you time and money.

    We want to provide you with the tools you need so you can make the best decisions for your patients.

    Included in this site, and accessed through a secure portal, is patient data such as claims history and prior authorizations. In addition, you will find forms, newsletters, the Health Choice Generations Provider Manual, continuing education information and links to other medical and dental information.

    Please contact the Provider Portal Coordinator at:

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    Extra Help With Costs: Lis Premium Summary Table

    UnitedHealthcare Dual Complete® Choice

    Monthly Plan Premium for People who get Extra Help from Medicare to Help Pay for their Prescription Drug Costs

    If you get extra help from Medicare to help pay for your Medicare prescription drug plan costs, your monthly plan premium will be lower than what it would be if you did not get extra help from Medicare. The amount of extra help you get will determine your total monthly plan premium as a member of our Plan.

    This table shows you what your monthly plan premium will be if you get extra help.

    Your level of extra help Monthly Premium*

    *This does not include any Medicare Part B premium you may have to pay.

    If you arent getting extra help, you can see if you qualify by calling:

    • 1-800-Medicare of TTY users call 1-877-486-2048 ,
    • Your State Medicaid Office, or
    • The Social Security Administration at 1-800-772-1213. TTY users should call 1-800-325-0778 between 7 a.m. and 7 p.m., Monday through Friday.

    Your health care needs are unique. These documents can help you make sure you get the right coverage.

    Documents include Annual Notice of Changes, Evidence of Coverage, Formularies, Medicare Plan Star Ratings, Provider Directories, Summary of Benefits, Other downloadable resources.

    Unitedhealthcare Connected For Mycare Ohio

    Super Cool Logo Needed For Health Insurance Company In Utah

    UnitedHealthcare Connected® for MyCare Ohio is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees. If you have any problem reading or understanding this or any other UnitedHealthcare Connected® for MyCare Ohio information, please contact our Member Services at from 7 a.m. to 8 p.m. Monday through Friday for help at no cost to you.

    Si tiene problemas para leer o comprender esta o cualquier otra documentación de UnitedHealthcare Connected® de MyCare Ohio , comuníquese con nuestro Departamento de Servicio al Cliente para obtener información adicional sin costo para usted al de lunes a viernes de 7 a.m. a 8 p.m. .

    This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook. Limitations, copays, and restrictions may apply. For more information, call UnitedHealthcare Connected Member Services or read the UnitedHealthcare Connected Member Handbook. Benefits, List of Covered Drugs, pharmacy and provider networks and/or copayments may change from time to time throughout the year and on January 1 of each year.

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    Unitedhealthcare Senior Care Options Plan

    UnitedHealthcare SCO is a Coordinated Care plan with a Medicare contract and a contract with the Commonwealth of Massachusetts Medicaid program. Enrollment in the plan depends on the plans contract renewal with Medicare. This plan is a voluntary program that is available to anyone 65 and older who qualifies for MassHealth Standard and Original Medicare. If you have MassHealth Standard, but you do not qualify for Original Medicare, you may still be eligible to enroll in our MassHealth Senior Care Option plan and receive all of your MassHealth benefits through our SCO program.

    Utah Medicaids Accountable Care Organizations

    Utah Medicaid currently works with four Accountable Care Organizations, which are sort of like health plans. Anyone in Box Elder, Cache, Davis, Iron, Morgan, Rich, Salt Lake, Summit, Tooele, Utah, Wasatch, Washington, or Weber counties is required to select one of the four. Anyone in another county can choose an ACO but does not have to. The benefit of joining an ACO is that they might offer additional benefits that the Medicaid program does not provide on its own. The advantage of not selecting an ACO is that you can see any doctor that accepts Utah Medicaid insurance.

    Anyone who lives in one of the counties listed above can change plans any time during their first 90 days. Additionally, anyone can change plans from mid-May through mid-June.

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    Steward Health Choice Utah

    Steward Health Choice serves Beaver, Box Elder, Cache, Davis, Iron, Juab, Millard, Morgan, Rich, Salt Lake, Sanpete, Sevier, Summit, Toole, Utah, Wasatch, Washington, and Weber counties. The Stewards Health Care Network owns five hospitals: Davis Hospital and Medical Center , Jordan Valley Medical Center , Jordan Valley Medical Center West Valley Campus , Salt Lake Regional Medical Center , and Mountain Point Medical Center .

    Unitedhealthcare Dual Complete Plans

    BYU-Idaho not accepting Medicaid

    Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plans contract renewal with Medicare. This plan is available to anyone who has both Medical Assistance from the State and Medicare. This information is not a complete description of benefits. Call TTY 711, or use your preferred relay service for more information. Limitations, co-payments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.

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    Get The Extra Benefits You Deserve

    We care about you and we are dedicated to improving the health and well-being of the people and communities we serve!

    Davis, Salt Lake, Tooele, Utah, and Weber counties.

    Member Information

    Health Choice Generations Utah is a HMO D-SNP with a Medicare contract and a contract with the state Medicaid program. Enrollment in Health Choice Generations Utah depends on contract renewal. If you speak a language other than English, language assistance services, free of charge, are available to you. Call , 8 a.m. – 8 p.m., 5 days a week and 7 days a week .

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