***BREAKING NEWS*** From UnitedHealthcare
Here is a copy of a letter we received from UnitedHealthcare regarding their transition of all their Centennial Care Members which will now go to the Presbyterian Health Plan.
Re: UnitedHealthcare Centennial Care Members Will Transition to Presbyterian Health Plan on Sept. 1, 2018
Effective Sept. 1, 2018, UnitedHealthcare Community Plan will no longer
provide services to New Mexico Centennial Care members. We’re
working to transition all UnitedHealthcare Community Plan Centennial Care members
to Presbyterian Health
Plan Centennial Care by Sept. 1, 2018.
This change doesn’t affect Medicare coverage for UnitedHealthcare dual special needs plan (DSNP) members
in New Mexico.
UnitedHealthcare DSNP will continue to be their primary plan for Medicare covered benefits and services; Presbyterian Health Plan Centennial Care will provide
their Medicaid coverage
as of Sept 1, 2018.
What Happens Next
We’re committed to a smooth transition for our UnitedHealthcare Centennial Care members to help ensure they continue to get the quality
care they are accustomed to. We’ve sent letters and support information about this change
to affected members.
Presbyterian Health Plan will be sending
them updated member ID cards and plan documentation in the coming days.
We’ll work directly with Presbyterian Health Plan to provide them with information about continuity of care and current member treatment plans.
Member Care Through Aug. 31
Eligibility and Benefits: Please continue to verify
member eligibility and health plan effective dates to help your office determine
if a member has already chosen another health plan.
Claims Submission: You should continue to submit
claims to UnitedHealthcare Community Plan for UnitedHealthcare Centennial Care members with dates of service
up to and including Aug. 31, 2018. UnitedHealthcare Community Plan will remain responsible for all medically
necessary services rendered to our members
through Aug. 31 at 11:59 p.m. We will also remain responsible for all medically
necessary hospital inpatient services rendered to our members hospitalized as of Aug. 31, up to and including their date of discharge. UnitedHealthcare will reject all claims with dates of service
on or after Sept. 1, 2018, except for medically necessary hospital inpatient services where the member
was admitted on or before Aug. 31, and remains hospitalized after Aug. 31.
Member Questions: If members have questions, please ask them to call us at 877-236-0826.
Member Care On or After Sept. 1
You can continue to see former UnitedHealthcare Centennial Care members who are now Presbyterian Health Plan members.
Beginning Sept. 1, you’ll submit claims for these members
to Presbyterian Health Plan. If you have questions or concerns
about your contractual status with Presbyterian Health Plan, please
call their Network Management line at 505-923-8584, between
8 a.m. and 5 p.m.
Our care provider
dispute and appeal process will remain the same. Please
consult your contract
and the Care Provider
Manual for more detailed
information. The Care Provider
Manual also has information about the process for submitting appeals and other requests on behalf
of members. You can find it at UHCprovider.com/NMcommunityplan > Provider
Administrative Manuals and Guides > New Mexico.
We’re Here to Help
To help make this transition easier for you, our network contracting and provider services staff will continue
to be available
after Aug. 31 to address
any questions or concerns.
Additionally, you can continue to access
UHCprovider.com for information and support. If you have questions, please call Provider Services at 888-702-2202 or Network
Management at 866-574-6088.
Thank you for the care you’ve provided to our Centennial Care members. Sincerely,
Nancy l Chapa
Director of Network Operations