United Healthcares Online Solutions Hartwig Moss


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  • It’s all about providing a seamless integrated level of support to employers, to reduce administrative time, at every step in the relationship.
  • UnitedHealthcare offers different eligibility options to meet the unique needs of their customers. Although paper enrollment is available to customers it is the least desirable option. It is the most error prone with 5% return rate, 98% accuracy keying rate and a 2% error ratio. This means delays from when an employee submits their election form to when they are actually eligible to receive benefits. There are two Self-Service Eligibility options: Web-Based Eligibility Updates and Updates Made through the Electronic Eligibility System. Web-Based Eligibility Updates: Ideal for smaller customers Ideal for customers with little turnover and few adds updates or changes Ideal for customers whose HR system lacks the ability to produce an electronic eligibility file Benefits: Changes are all real-time, therefore adds, terms, and changes are reflected immediately in UnitedHealth Group systems Electronic Eligibility Management System Ideal for larger customers The process is totally automated – the customer sends eligibility file directly to UnitedHealthcare via secure electronic transmission Changes are not real-time. It take up to 24 hours for changes to take effect.
  • Our billing system connects our eligibility and billing systems for maximum efficiency and accuracy. Describe arrow diagram SB – all new clients its standard for electronic invoicing KA/PS – standard for all clients electronic invoicing Enhancements- Account Summary will display open invoices, closed invoices and account balances. Customers will be able to view 13 months of invoice history as well as payment history. All payments will be noted regardless of payment method. Last Payment Date & Amount, Next Payment Due Date & Amount will be displayed Requesting Adjusted Invoices can now be done for eligibility invoices and head-count changes to self-billed invoices. Account History – Past Due Aging provides an Aging Information section that will reflect the customer's past due balance (positive or negative). Days overdue (Future, Current (0-30), 31-60, 61-90, 91-120, 120+) will be displayed. Ability to Create Multiple Payment Methods allows your customers to set up multiple payment methods online and select any of the methods to initiate payment. Single Customer Access will enable broker-level users to access one client at a time. Enhanced Notifications will inform your customers when their online payment has been received, offer pre- and post-termination alerts. Brokers will receive one email notification for each bill run instead of receiving an online notification for each customer.
  • You can use the Communication Resource Center on Employer eServices to download employee marketing and promotion material like newsletter or e-mail content, workplace wellness plans, brochures, posters, flyers, and check stuffers to help you promote wellness.
  • On cover page, “Presentation Title” is always in PMS 072. Cover page is the only page that has photos this size. Cover page is the only page that has the logo with the tagline and “flying U.” Cover page uses screened-back PMS 072 text in all lowercase letters as an identifier to the “Presentation Title.” The word can be different than “presentation” and is always used with the “Presentation Title.”
  • Employee Support Mailing of qualifying event notices Reminders regarding account status Monthly premium collection including reminders of partial or late payments Employer Support Examination/reconciliation of current participants’ account status for takeover Payment Coupons provided to new participants Immediate notification of new elections or terminations Prompt delivery of monthly consolidated check for received premiums Technical assistance on questions about administration of compliance Reporting Full Compliance Services Appropriate distribution of HIPAA certificates when coverage expires or is discontinued Newsletters to inform you of regulatory changes Seven-year minimum data archival
  • Background As part of continuing program enhancement efforts, UnitedHealthcare launched an improved Healthy Pregnancy Program Web site in March 2009 to provide expectant mothers with enhanced online education, interactive tools and robust support throughout pregnancy, childbirth and beyond. Members newly enrolling in the Healthy Pregnancy Program will also receive a Mom(me) kit and breastfeeding DVD. The new Mom(me) kit focuses on the me in mommy and includes information to help expectant mothers make healthy choices during and after pregnancy. In addition to the updated Web site and the Mom(me) kit, members enrolling in the Healthy Pregnancy Program will also receive the Journey Through Pregnancy book, access to the award-winning online Healthy Pregnancy Owners Manual, and a discount on PJs Comfort® breast pumps.  The Healthy Pregnancy Program The Healthy Pregnancy Program, available to all fully insured and self-funded customers, has enrolled more than 270,000 pregnant women since its inception in 2004. Enrollment has risen every year as the benefits of the program and the support provided to mothers has improved. The Healthy Pregnancy Program supports mothers with educational resources and case management nurses who coordinate clinical services, focusing on outcome-based care management to improve the quality and affordability of care throughout pregnancy.  The goal of the program is to identify pregnancies that are clinically determined to be at risk for low birth weight or premature delivery. Early identification of these pregnancies and enrollment in the program allows us to assign each high-risk mother to a care management nurse who assists and supports the mother throughout her pregnancy. The program to date has identified and managed more than 41,000 high-risk cases. Early intervention and support by our nurses has proven to increase the gestational age of babies and increase birth weights, thereby reducing neonatal intensive care costs. Contact: Kristen Pfeister, OptumHealth Product Manager, (763) 797-4118; Mary Lynn Hildebrand-Hitz, UnitedHealthcare Womens Health Line of Service, (952) 992-5711
  • Talking points: It’s key for our members and physicians to understand costs and coverage prior to treatments. Both the Treatment Cost Estimator and Claim Estimator are the perfect tools for this use. Having information in advance helps our members and their physician understand their options and cost implications. These tools also help facilitate patient/doctor discussions which can ultimately lead to better health care decisions. Treatment Cost Estimator Provides a personalized, comprehensive estimate that helps members understand the costs associated with specific treatment options. Cost information is no longer an unknown to the member, which aids in planning and budgeting. Estimates are broken down by physician, facility, radiology, laboratory, supplies, medication, and other treatment-related fees Health plan information is applied to the estimate, including the member’s deductible, out of pocket maximum, copayments, and coinsurance Both network and non-network estimates are available Claim Estimator Also called ‘pre-determination of benefits’ Estimate shows if the member is covered for a specific procedure, at what amount, and what the physicians claim reimbursement will be. Estimate gives physicians any defined remark codes prior to their claim submission. A real time pre-determination response will not be returned for members covered under government plans (COSMOS platform).
  • In mid 2006 we introduced our first consolidated health statement and with second version we released in January 2008 90% of our customer have replaced the out dated EOB’s with the consolidated health statement. Instead of receiving numerous EOBs for each particular claim/date of service, members are mailed a comprehensive Health Statement summarizing all EOB information into one user-friendly, easy-to-read, and easy-to-understand statement. By providing one member statement that pulls together all EOB information, consumers can see a clearer picture of their overall health care spending. The goal of the health statement is to aid consumers Better understand their health care costs Become better consumers of health care services Simplify their health care services’ experience Example – Credit Card Statement – one statement for all summarized activity for a given period.
  • United Healthcares Online Solutions Hartwig Moss

    1. 1. eSolutions Simpler, Easier, Better ® UnitedHealthcare’s “Online Solutions for Employers and Members”
    2. 2. Agenda <ul><li>Employer eServices (Employer) </li></ul><ul><li>UnitedHealthcare Benefit Services’ (Employer) </li></ul><ul><li>myuhc.com (member) </li></ul>Leveraging technology to change the face of health care
    3. 3. Leveraging technology to change the face of health care <ul><li>Employer eServices ® </li></ul><ul><li>Simply easier ways to administer benefits efficiently </li></ul><ul><li>Who uses the Employer eservices Web Site? </li></ul><ul><ul><ul><li>• Group administrators and their designees </li></ul></ul></ul><ul><ul><ul><li>• Brokers </li></ul></ul></ul>
    4. 4. Employer eServices Home Page Add Terminate Reinstate Change Inquire Electronic File Order ID Cards View Claims Account Summary Payment History Change Payment Method Financial Reports and Analysis View Banking Reports Online Manage access to EeS Tools Links and information
    5. 5. Eligibility Options for all Employers Paper Enrollment <ul><li>Employees give enrollment election form to Employer </li></ul><ul><li>Employer faxes or mails paper form </li></ul><ul><li>Legible issues / missing data </li></ul><ul><li>5% return rate – creates delays in accessing health care system </li></ul><ul><li>98% accuracy keying rate </li></ul><ul><li>2% error ratio. More delays… </li></ul>Least desirable. Most error prone. Excessive delays. Web-Based Eligibility Updates <ul><li>Customer keys eligibility changes into system in real-time </li></ul><ul><li>Ideal for customers whose HR system lacks the ability to produce an electronic eligibility file </li></ul><ul><li>Adds, terms, changes are reflected immediately in UnitedHealth Group systems </li></ul>Ideal for urgent or lower volume eligibility transactions Real-time 24 – 48 Hours Solutions for facilitating employees’ benefit enrollment process Manual Self-Service
    6. 6. Electronic Bill Presentment and Payment <ul><li>Account Summary </li></ul><ul><li>View account balance </li></ul><ul><li>View current outstanding invoices </li></ul><ul><li>View closed invoices </li></ul><ul><li>View invoice details </li></ul><ul><li>View payment history </li></ul><ul><li>Print bill at customer site </li></ul><ul><li>On-line Payment </li></ul><ul><li>Scheduled direct debit </li></ul><ul><li>Pay invoices online </li></ul><ul><li>Request Adjustment Invoice </li></ul><ul><li>Email Notification </li></ul><ul><li>New User Registration </li></ul><ul><li>Invoice ready for view and payment </li></ul><ul><li>Request adjustment invoice </li></ul><ul><li>Pre and post termination </li></ul>eServices Bill Presentment and Payment Eligibility Processing Invoice Distribution Payment Processing <ul><li>Electronic </li></ul><ul><li>Employer Portal </li></ul><ul><li>OnlinEnroll </li></ul><ul><li>Elec Elig Mgmt </li></ul><ul><li>Electronic </li></ul><ul><li>Online Billing </li></ul><ul><li>View Invoice </li></ul><ul><li>Adjustments </li></ul><ul><li>Electronic </li></ul><ul><li>Online Billing </li></ul><ul><li>Pay on-line </li></ul><ul><li>Direct Debit </li></ul>
    7. 7. Communication tools <ul><li>Communication Resource Center (CRC) </li></ul><ul><ul><li>Health and wellness articles & e-mail content </li></ul></ul><ul><ul><li>Downloadable communication templates, toolkits, brochures, fliers, check stuffers, and posters </li></ul></ul><ul><ul><li>Customized newsletters using the “Build a Custom Newsletter” capability </li></ul></ul><ul><ul><li>Workplace wellness template work plans </li></ul></ul>
    8. 9. UnitedHealthcare Benefit Services Bundled Value Services: COBRA, FSA, PTP
    9. 10. COBRA <ul><li>For UHC medical clients with 20-99 eligible employees, UBS will handle COBRA administration at no cost for all eligible plans – </li></ul><ul><li>even those with other vendors </li></ul><ul><li>We will service all your COBRA needs with assured compliance and efficient record keeping </li></ul><ul><li>Simplified administration for Employers </li></ul><ul><ul><ul><ul><ul><li>Federal COBRA Administration </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Pre-Tax Premium Administration (PTP) </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Flexible Spending Accounts (FSA) </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Single provider allows one-stop shopping </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Ease of administration </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Limited employer liability </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Reduction of payroll-related taxes </li></ul></ul></ul></ul></ul>
    10. 11. Leveraging technology to change the face of health care myuhc.com ® Simply easier access to helpful information and support for your employees April 9, 2009: UnitedHealth Group Earns Six 2008 World Wide Web Health Awards for Superior Online Content .
    11. 12. Personalized, Relevant Online Data Promotes Engagement and Activation <YOU> <Your Name> <ul><li>Compare physicians and hospitals, including quality and efficiency designations </li></ul><ul><li>See the cost of different prescription choices </li></ul><ul><li>Consider mail order for additional savings </li></ul><ul><li>Understand costs across treatment options </li></ul><ul><li>Review health care activity, account balances and claims </li></ul>Better health decisions supported @myuhc.com Member enrollment on our consumer Web site increased 14 points in 2008 to 64%.
    12. 13. Explore the Health & Wellness Homepage Online Health Assessment Online Health Coach Personalized articles Personalized clinical content Trackers, Tools Personal Health Record
    13. 15. Health Discount Program
    14. 16. <ul><li>Enhanced website: www.healthy-pregnancy.com </li></ul><ul><li>Award-winning online pregnancy owner’s manual: http://mypregnancymanual.com/uhc </li></ul>Healthy Pregnancy Program <ul><li>No cost to members </li></ul><ul><li>Identification of special needs or risks </li></ul><ul><li>24-hour toll-free access to experienced OB nurses </li></ul><ul><li>Participants receive: </li></ul><ul><li>Mom(me) kit </li></ul><ul><li>Breastfeeding DVD </li></ul><ul><li>Journey Through Pregnancy book </li></ul><ul><li>Breast pump discount </li></ul>Healthy Pregnancy Program
    15. 17. New enhanced Treatment Cost Estimator <ul><li>An enhanced Treatment Cost Estimator was deployed to myuhc.com on June 30th. This tool provides personalized, comprehensive cost estimates to assist  consumers in understanding the expenses associated with their treatment options. </li></ul>Search/Select Treatments Search/Select Physicians View Estimates Select Member & Location Previous TCE Tool Redesigned TCE Tool Estimates incorporate the individual member’s deductible & OOPM accumulators Estimates will be based on member’s own benefit plan (deductible, OOPM accumulators, co-payments, co-insurance, etc.) Estimates are based on cross-payer geographical median claim amounts. Estimates will be based on United Healthcare contracted rates for providers’ professional services. Facility assumptions are incorporated in calculations Estimates are provided by facility type to show cost differences and opportunities for savings.
    16. 18. Health Care Transparency “ Wonder how much this procedure will cost; would like to start planning and budgeting now” myuhc.com ® Treatment Cost Estimator Members Physicians “ Wonder if she’s covered for the procedure and what our reimbursement will be” UnitedHealthcareOnline.com ® Claim Estimator
    17. 19. Health Care Simplicity Simplicity…is having a single integrated health care statement One comprehensive statement provides detailed content on account balances and claim activity. A statement summarizes Explanation of Benefit information to help consumers get a clearer picture of their overall health care spending.
    18. 20. Try the Web sites for yourself… Interactive Session Download Demos to your Desktop WelcometoEmployereServices.com Welcometouhcservices.com Welcometomyuhc.com
    19. 21. UnitedHealthcare…radically changing health care <ul><li>Thank you for your time! </li></ul>