Frequently Asked Questions For Care Providers and Practice Managers

UnitedHealthcare Dual Complete® ONE A Fully Integrated Dual Special Needs HMO Insurance Program for Medicare- and Medicaid-eligible members in New Jersey

Frequently Asked Questions  What is UnitedHealthcare Dual Complete® ONE?  Who are Dual Complete ONE beneficiaries?  Is Dual Complete ONE accepted state-wide in New Jersey?  How do I know if I’m contracted to provide services for Dual Complete ONE members?  If I already have a current contract with UnitedHealthcare Medicare Solutions and UnitedHealthcare Community Plan, am I automatically contracted to provide services for Dual Complete ONE?  If a member has a Medicare card and a Medicaid card, do they have automatically have D-SNP?  Which member insurance ID card should our practice accept?  What does a Dual Complete ONE member ID card look like?  How can I check to see if a member is enrolled with Dual Complete ONE?  How do I submit claims for Dual Complete ONE?  What extra benefits do members receive with Dual Complete ONE?  If I’m not a participating care provider for Dual Complete ONE, how can I become contracted?  Who can I contact if I have questions?  What other references can I use to learn more about Dual Complete ONE? Note: UnitedHealthcare Dual Complete® ONE and Dual Complete ONE may be used interchangeably in this presentation. 2 Doc#: PCA-1-003877-10252016_11082016Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

What is UnitedHealthcare Dual Complete® ONE? Dual Complete ONE (HMO SNP) is a single-payer, fully integrated Dual Eligible Special Needs Plan (D-SNP) provided through UnitedHealthcare Community Plan for beneficiaries who have Medicare* and Medicaid coverage. It’s a health insurance plan designed for individuals who don’t have any cost sharing responsibility. HMO SNP = Health Maintenance Organization Special Needs Plan.

Who are Dual Complete ONE beneficiaries? Beneficiaries who have both Medicare* and Medicaid coverage are often referred to as dual-eligible. To simplify the health coverage benefits of having both, fully integrated means that Dual Complete ONE combines both Medicare* and Medicaid coverages into one insurance plan.

Medicare

Medicaid

Federal Health Insurance Program

State Health Insurance Program

UnitedHealthcare Dual Complete® ONE UnitedHealthcare Community Plan Medicare & Medicaid fully integrated insurance plan

* To be eligible for UnitedHealthcare Dual Complete® ONE, beneficiaries must be entitled to Medicare Part A and enrolled in Medicare Part B. 3 Doc#: PCA-1-003877-10252016_11082016Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Service Area Is UnitedHealthcare Dual Complete® ONE accepted state-wide in New Jersey?

Sussex

In 2017, UnitedHealthcare Dual Complete® ONE will service members in the following counties:

Passaic Bergen Morris

Warren

Atlantic Bergen Burlington Camden * Essex Gloucester * Hudson Hunterdon *

Mercer Middlesex * Monmouth Morris Ocean Passaic * Somerset * Union

Essex Hudson Union Hunterdon

Newark

Somerset

New Brunswick

2016 counties

Middlesex

Long Branch

Mercer

Trenton

Monmouth

2017 expansion counties

Toms River Burlington

Ocean

Camden

* 2017 Dual Complete ONE expansion counties Gloucester Salem

Dual Complete ONE members may visit in-network contracted care providers state-wide.

Atlantic

Atlantic CIty

Cumberland

Cape May

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Contracting How do I know if I’m contracted to provide services for Dual Complete® ONE members? If you’re unsure if you’re a contracted care provider for Dual Complete ONE, you can verify your participation by calling Provider Services at 888-362-3368, Monday through Friday 6 a.m. to 6 p.m. ET.

If I already have a current contract with UnitedHealthcare Medicare Solutions and UnitedHealthcare Community Plan, am I automatically contracted to provide services for Dual Complete ONE? No. If a care provider has a current contract to participate with Medicare (UnitedHealthcare Medicare Solutions) and Medicaid (UnitedHealthcare Community Plan NJFamilyCare), it doesn’t automatically mean they’re contracted with Dual Complete ONE. Some care provider contracts are set up differently. Please contact Provider Services at 888-362-3368 to verify if you’re currently contracted to provide services for members covered under Dual Complete ONE. Reimbursement for Dual Complete ONE is based on your UnitedHealthcare Community Plan network agreement.

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Member ID Cards If a member has a Medicare card and a Medicaid card, do they automatically have D-SNP? No, having Medicare and Medicaid coverage doesn’t necessarily mean that a member is automatically enrolled in a D-SNP or has that coverage. However, the member may be eligible to enroll in Dual Complete ONE because they’ve signed an enrollment form stating that they agree to enroll in the plan. A D-SNP member must enroll in a private health insurance plan that offers integrated coverage for both Medicare and Medicaid, such as Dual Complete ONE. Beneficiaries can find more information about enrolling in the plan at UHCCommunityplan.com > New Jersey > 2017 UnitedHealthcare Dual Complete® ONE (HMO SNP) > Steps to Sign Up.

Which member insurance ID card should our practice accept? Dual Complete ONE members are issued a single ID card. When a member has a Dual Complete ONE ID, it means they’re:  Entitled to Medicare Part A and is enrolled in Medicare Part B  Entitled to full Medicaid  Enrolled in the Dual Complete ONE plan because they signed an enrollment form  Familiar with the benefits of the Dual Complete ONE plan because they reviewed them with a licensed UnitedHealthcare Community Plan representative

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Sample Member ID Card What does a Dual Complete ONE member ID card look like?

As the care provider, you don’t need to ask a member with the above Dual Complete ONE ID card for his/her Medicare and/or Medicaid ID card. The Dual Complete ONE ID card already represents that they have both coverages. Use the Dual Complete ONE UnitedHealthcare Medicare ID on the card as the member ID # when submitting claims for reimbursement.

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Checking Member Enrollment How can I check to see if a member is enrolled with Dual Complete ONE? Log on to or register for an account at UnitedHealthcareOnline.com > Patient Eligibility & Benefits to see if the patient is enrolled and to check their eligibility dates.

You can also call Provider Services at 888-362-3368, Monday through Friday, 6 a.m. to 6 p.m. ET. Please have the following information ready: • Your National Provider Identifier (NPI) or Tax ID # • Name of care provider practice or facility • Member ID # if you have it • Member name • Member date of birth 8 Doc#: PCA-1-003877-10252016_11082016Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Claim Submission How do I submit claims for Dual Complete ONE? UnitedHealthcare Community Plan has an automated system for seamless processing of claims for members enrolled in both the UnitedHealthcare Community Plan Medicaid and Medicare under Dual Complete ONE. Using the member’s UnitedHealthcare Medicare ID from the Dual Complete ONE ID card, you’ll only need to submit one claim. Your claims will automatically be processed first against the Medicare benefits and then against the Medicaid benefits. Expect to receive two provider remittance advices (PRAs), one for Medicare and one for Medicaid. There’s no need to resubmit a secondary claim to UnitedHealthcare Community Plan. Electronic Claims Submission

Mailed Claims Submission

Use Payer ID 86047 UnitedHealthcareOnline.com > Claims & Payments > Claim Submission (CMS-1500 claims only)

UnitedHealthcare Dual Complete® ONE P.O. Box 5250 Kingston, NY 12402-5250

Dual Complete® ONE members should not be balance billed for any covered benefit. 9 Doc#: PCA-1-003877-10252016_11082016Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Additional Benefits What extra* benefits do members receive with Dual Complete ONE? 

Health Products Debit Card with up to $564 in annual credits to buy health products at participating retailers

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Health Products Catalog with up to $700 in annual credits to order health products which will be delivered directly to the member at no additional cost

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$0 co-pay for personal emergency response system for extra support in emergencies

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SilverSneakers® fitness program, which allows members to join a health club or fitness center at no additional cost

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24-hour NurseLineSM to speak with a nurse any time

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No referrals needed for network specialists

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$0 premium and cost-sharing, including Medicare Part D co-pays

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Medicare Part D “Extra Help” covers Part D premium

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Medicaid covers all Medicare cost sharing on behalf of members

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Additional Medicaid benefits offered at $0 co-pay

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Additional Medicaid-only drugs covered beyond Medicare Part D Large provider network

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co-

* UnitedHealthcare Dual Complete ® ONE offers additional benefits beyond those offered through original Medicare. 10 Doc#: PCA-1-003877-10252016_11082016Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Contracting and Contacts If I’m not a participating care provider for Dual Complete ONE, how can I become contracted? Call Provider Services at 888-362-3368 to find out if you’re a participating D-SNP care provider. If you aren’t, let the representative know that you’re interested in obtaining a contract amendment to include serving Dual Complete ONE D-SNP members. A Provider Network Advocate will contact you to assist with your contract.

Who can I contact if I have questions? If you have questions, please call Community Plan Provider Services for Dual Complete ONE and NJFamilyCare/Medicaid at 888- 362-3368, Monday through Friday, 6 a.m. to 6 p.m. ET. OR Dual Complete ONE Member Services 800-514-4911, TTY: 711, 7 days a week, 8 a.m. to 8 p.m. local time.

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Additional Resources What other references can I use to learn more about Dual Complete ONE? Click here  to view and print a copy of the UnitedHealthcare Dual Complete® ONE Quick Reference Guide (QRG)

 Click here to view and print a UnitedHealthcare Dual Complete® ONE Benefit Structure.

 Click here to reference the UnitedHealthcare Community Plan Provider Administrative Guide for additional information on UnitedHealthcare Dual Complete® ONE guidelines. Click here  to learn more about UnitedHealthcare Dual Complete® ONE member benefits. 12 Doc#: PCA-1-003877-10252016_11082016Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.