UnitedHealthcare Community Plan

OhioRISE

How to request a member handbook, provider directory, waiver handbook and advance directive

Check back for announcements.

If you have questions about Unitedhealthcare Community Plan of Ohio, please call us. Our toll-free Member Services number is 1-800-895-2017, TTY 711 or use your preferred relay service. Chúng tôi làm việc từ 7 SA đến 7 giờ chiều/CH, giờ địa phương, thứ Hai đến thứ Sáu. 

Offices are closed for the following holidays: New Year’s Day, Martin Luther King Jr. Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day, and the Day After Thanksgiving, plus Christmas Day

OhioRISE

If you have questions around OhioRise, please call:
1-833-711-0773 (TTY: 711)

7 SA đến 7 giờ chiều/CH, giờ địa phương, thứ Hai - thứ Sáu

Offices are closed for the following holidays: New Year’s Day, Martin Luther King Jr. Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day, Day After Thanksgiving, Christmas Day

You can also write OhioRISE:

Aetna Better Health of Ohio

c/o OhioRISE Plan

Lưu ý: Dịch vụ Hội viên

7400 West Campus Rd, Suite 200

New Albany, OH 43054

Ownership Information

Three Rivers Holdings, Inc.

Officers 

Board of Directors 

UnitedHealthcare Community Plan cung cấp tài liệu cho hội viên bằng ngôn ngữ hoặc định dạng giúp quý vị dễ hiểu hơn. Mạng lưới nhà cung cấp dịch vụ chăm sóc của chúng tôi bao gồm nhiều bác sĩ đa ngôn ngữ. Danh bạ nhà cung cấp của chúng tôi cho biết ngôn ngữ bác sĩ sử dụng. Additionally, many of our Member Services Advocates speak multiple languages, so when you call, they will be able to help you or connect you with our interpreter service which covers more than 170 languages. 

Nếu quý vị gặp khó khăn khi nghe điện thoại, quý vị có thể sử dụng điện thoại tin nhắn. Dịch vụ miễn phí này cho phép người khiếm thính hoặc khiếm ngôn thực hiện và nhận cuộc gọi điện thoại. Call 711, give them the Member Services number, 1-800-895-2017, and they will connect you to us. 

You can also get information in large print, Braille, or audio tapes. We can also assist with interpreter services, including American Sign Language. To ask for help, please call us Monday through Friday, 7 SA to 7 giờ chiều/CH Local Time. 

Our toll-free Member Services number is 1-800-895-2017, TTY: 711.

For language and translation help related to OhioRISE, please call Member Services: 

1-833-711-0773 (TTY: 711)

7 SA to 7 giờ chiều/CH, local time Monday - Friday

Offices are closed for the following holidays: New Year’s Day, Martin Luther King Jr. Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day, Day After Thanksgiving, Christmas Day

or visit the OhioRISE website

UnitedHealthcare OMW^TM (UnitedHealthcare On My Way) is an interactive website that helps you get ready for real life. It's easy and fun, and has important information all on one secure site.

Download the brochure to find out more about

Money: Set up a budget and learn about taxes.
Housing: Understand and compare housing options.
Work: Create a resume and learn interview tips.

And more!

https://member.uhc.com/communityplan is the secure member website for UHC Community Plan of Ohio. Xem các quyền lợi được bao trả của quý vị, tìm kiếm nhà cung cấp dịch vụ chăm sóc, xem sổ tay hội viên và nhiều dịch vụ khác.

UnitedHealthcare Care Managers for Member's Unique Needs

Every UnitedHealthcare MyCare Ohio member receives a personal representative. These Care Managers are licensed professionals providing education and coordination of UnitedHealthcare Connected^® for MyCare Ohio (Medicare Medicaid Plan) benefits, tailored for each member's unique needs.

Click here to watch a video on how these Care Managers are helping current members.

We recently mailed you a letter that included some information on benefit changes. Some of the information did not pertain to members that only have their Medicaid covered benefits through our plan. Please disregard that letter. The letter also had an incorrect number for the Ohio Medicaid Hotline. The correct number for the Hotline is 1-800-324-8680. We are sorry for any confusion this may have caused you. Please view the Member Clarification Letter for additional information.

Use the documents below to learn more about each important health topic.

UnitedHealthcare Member Advisory Council and "Connected Advisors"

UnitedHealthcare Member Advisory Council and "Connected Advisors" is an advisory council to ensure that UnitedHealthcare actively engages consumers, families, advocacy groups, and other key stakeholders as partners in the program design and delivery system.

Who is involved?

• Any members, or a member's representative, are eligible to participate.
• There are no term limits for participation.
• Representatives from member stakeholder or advocacy organizations.
• Representation reflects the diversity of the member population including: race, ethnicity, religion, sexual orientation, gender, disability (physical or mental), age, parental status, or genetic information.

They will advise and guide the UnitedHealthcare Community Plan of Ohio on:

• Clinical design and delivery
• Strategies to support members in the community
• Abuse and neglect initiatives
• Promote member-centric culture
• Provide input regarding research and best practices

How is it organized?

• Three local groups of "Connected Advisors" with representation in the Northeast (Cuyahoga, Geauga, Lake, Lorain, and Medina counties); Northeast Central (Columbiana, Mahoning, and Trumbull counties); and East Central (Portage, Stark, Summit, and Wayne counties) MyCare Ohio regions.

What will they do?

• Participate in quarterly conference calls or in-person meetings.
• There is no cost for participation.
• Decisions of the Member Council and Connected Advisors will be made by simple majority vote of members present.
• One member will be appointed/elected to participate in UnitedHealthcare's National Peer Ambassador program. The goal of a peer ambassador program is to elevate and empower members through meaningful dialogue, information exchange, and inclusion in the development of best practices, innovations, and delivery/design in promotion of a member-centered culture. The Community and National Peer Ambassadors connect virtually (via conference or web-based technology) to share experiences and insights regarding opportunities to better the quality of life and experience of the populations we serve. We leverage recommendations and insights shared by the Ambassadors to support improved outcomes and experiences in the promotion of a member-centered culture. The Ambassadors do not receive compensation for service in the ambassador role.

To learn more about UnitedHealthcare's Member Advisory Council and "Connected Advisors," or get involved, get information at https://member.uhc.com/communityplan or call Member Services at 1-800-895-2017 (TTY 711).

Các câu hỏi và tình huống y tế đôi khi phát sinh vào lúc không thuận tiện. When you have questions about your health and you are a member of UHC Community Plan of Ohio, you can call a nurse 24 hours a day, 7 days a week: 1-866-801-4407, TTY 711.

Các y tá của chúng tôi sẽ:

• Lắng nghe các triệu chứng của mình
  
• Hỗ trợ tự chăm sóc
• Tư vấn quý vị có thể nhận dịch vụ chăm sóc tại buổi thăm khám bác sĩ tiếp theo hoặc cần trung tâm chăm sóc khẩn cấp.
• Giúp quý vị biết được khi nào thì cần tới phòng cấp cứu

Healthchek is Ohio’s early and periodic screening, diagnostic, and treatment (EPSDT) benefit.

Healthcheck coverage

Healthchek covers medical exams, immunizations (shots), health education, and laboratory tests for Medicaid eligible individuals under the age of 21. Mothers should have prenatal exams and children should have exams at birth, 3-5 days of age and at 1, 2, 4, 6, 9, 12, 15, 18, 24, and 30 months of age. After that, children should have at least one exam per year.

Healthchek also covers medical, vision, dental, hearing, nutritional, developmental, and behavioral health exams, in addition to other care to treat physical, behavioral or other problems or conditions found by an exam. Some of the tests and treatment services may require prior authorization. 

Healthchek services are available at no cost to members and include:

• Preventive checkups for newborns, infants, children, teens, and young adults under the age of 21
  
• Healthchek screenings
• Medical exams (physical and development screenings) 
• Vision exams 
• Kiểm tra nha khoa 
• Hearing exams
• Nutrition checks 
• Developmental exams 
• Lead testing 
• Laboratory tests (age and gender appropriate exams) 
• Immunizations 
• Medically necessary follow-up care to treat health problems or issues found during a screening. 

This could include, but is not limited to, services such as visits with a primary care provider, specialist, dentist, optometrist and other; UnitedHealthcare Community Plan providers to diagnose and treat problems or issue; inpatient or outpatient hospital care; clinic visits; prescription drugs

Giáo dục sức khỏe

It is very important to get preventive checkups and screenings so your providers can find any health problems early and treat them, or make a referral to a specialist for treatment, before the problem gets more serious. Remember: Some services may require a referral from your PCP or prior authorization by UnitedHealthcare Community Plan. Also, for some EPSDT items or services, your provider may request prior authorization for UnitedHealthcare Community Plan to cover things that have limits or are not covered for members over age 20. Please see page 22 of the handbook to see what services require a referral and/or prior authorization.

As a part of Healthchek, care management services are available to all members under the age of 21 who have special health care needs. Please see page 35 of the handbook to learn more about the care management services offered by UnitedHealthcare Community Plan.

Member can obtain Healthchek services by:

• Calling your PCP and dentist to make appointments for regular checkups (making sure to ask for a Healthchek exam when you call the PCP), or by
  
• Calling UnitedHealthcare Community Plan Member Services if you have any questions or need assistance with accessing care, including finding a provider or making an appointment; services covered; transportation; prior authorizations; referrals for Women, Infants, and Children (WIC), Help Me Grow, Bureau for Children with Medical Handicaps (BCMH), Head Start, and community services such as food, heating assistance, etc.

Chương trình Healthy First Steps của chúng tôi đảm bảo rằng cả mẹ và em bé đều được chăm sóc y tế tốt. 

Chúng tôi sẽ giúp quý vị: 

• Nhận lời khuyên tốt về dinh dưỡng, thể dục và an toàn
• Chọn bác sĩ hoặc y tá đỡ đẻ
• Xếp lịch thăm khám và kiểm tra
• Sắp xếp các chuyến đi đến buổi khám bác sĩ
• Kết nối với các tài nguyên cộng đồng như các dịch vụ Phụ Nữ, Trẻ Sơ Sinh và Trẻ Em (Women, Infants and Children, WIC)
• Được chăm sóc sau khi quý vị sinh con
• Chọn bác sĩ nhi khoa (bác sĩ của trẻ)
• Nhận thông tin kế hoạch hóa gia đình

Clinical Health Guidelines

Chăm Sóc Trong Thời Kỳ Mang Thai

Viện Nhi Khoa Hoa Kỳ và Hội Sản và Phụ Khoa Hoa Kỳ, Ấn bản lần thứ sáu, Hướng Dẫn Chăm Sóc Trong Thời Kỳ Mang Thai

Tầm Soát Chăm Sóc Phòng Bệnh Nhi Khoa

2021 Recommendations for Preventive Pediatric Health Care screening guidelines (periodicity schedule) from the American Academy of Pediatrics

Viện Nhi Khoa Hoa Kỳ

Preventive Services Guideline

2021 Guide to Clinical Preventive Services – US Preventive Services Task Force (USPSTF)

Cơ Quan Nghiên Cứu và Chất Lượng Chăm Sóc Sức Khoẻ

For a description of the UnitedHealthcare practice guidelines, please write to:

UnitedHealthcare Community Plan Quality Improvement
5900 Parkwood Place
Dublin, Ohio 43016

If you need a ride to your medical provider, we may be able to help. UnitedHealthcare Community Plan will provide you with 30 one-way or 15 round trips per year to and from your primary care provider's office, WIC, pharmacy, or other participating health care or behavioral health care providers, such as vision, dental, and mental health and substance use providers. 

• You may also request help to get to your Medicaid redetermination visits.
• Mileage reimbursement is now available for those members or their representative that would prefer to use their own vehicle for trips to medical appointments. 
• Members must call for trips 5 days in advance.
• Unlimited trips for pregnancy, prenatal, post-partum, WIC appointments, NICU and children (younger than age 1) for well visits. 
• Advance notification waived. 
• Stand-alone pharmacy trips allowed.

Khỏe mạnh không luôn đi kèm với nhu cầu y tế khẩn cấp của quý vị. Đôi khi quý vị có thể cần giúp kết nối với các nguồn lực trong cộng đồng. Chúng tôi gọi đó là các nhu cầu xã hội. These are things like housing, getting food every day or feeling safe.  Visit findhelp.org for a list of resources.

Advance Care Planning

Chúng tôi có Thông Báo Về Cách Bảo Vệ Quyền Riêng Tư, giải thích cho quý vị biết về cách sử dụng và chia sẻ thông tin sức khỏe về quý vị. Theo yêu cầu của pháp luật, chúng tôi phải cho quý vị biết rằng hiện có Thông Báo này, và cách thức quý vị có thể có một bản Thông Báo.

Xem Thông báo về các Phương thức bảo vệ Quyền riêng tư của chúng tôi.

If you are unhappy with anything about UnitedHealthcare Community Plan or its providers, you should contact us as soon as possible. This includes if you do not agree with a decision we have made. You, or someone you want to speak for you can contact us. If you want someone to speak for you, you will need to let us know this. UnitedHealthcare Community Plan wants you to contact us so that we can help you. To contact us, you can:

• Call the Member Services department at 1-800-895-2017, TTY 711, or 
• Fill out the form in your member handbook, or 
• Call the Member Services department to request they mail you a form, or 
• Visit our website at https://member.uhc.com/communityplan, or 
• Write a letter telling us what you are unhappy about. Be sure to put your first and last name, the number from the front of your UnitedHealthcare Community Plan member ID card, and your address and telephone number in the letter so that we can contact you, if needed. You should also send any information that helps explain your problem. 

Mail the form or your letter to:

UnitedHealthcare Community Plan
Grievances and Appeals
P.O. Box 31364
Salt Lake City, UT 84131-0364

UnitedHealthcare Community Plan will send you something in writing if we make a decision to:

• deny a request to cover a service for you;
• reduce, suspend or stop services before you receive all of the services that were
• approved; or
• deny payment for a service you received that is not covered by UnitedHealthcare Community Plan.

We will also send you something in writing if, by the date we should have, we did not:

• make a decision on whether to cover a service requested for you, or
• give you an answer to something you told us you were unhappy about.

Download our Grievance and Appeal form.

If you are unhappy with OhioRISE or our providers, or do not agree with a decision we made, contact us as soon as possible. You, or someone you want to speak for you, can contact us. If you want someone to speak for you, you will need to let us know. OhioRISE wants to help.

To contact us, you can:

• Call Member Services at 1-833-711-0773 (TTY: 711).

• Fill out the Standard Appeal form in your member handbook on page 32. You can call Member Services to ask for a printed copy.

• Visit our website at AetnaBetterHealth.com/OhioRISE.

• Write a letter telling us what you are unhappy about. Please include your first and last name, the number from the front of your member ID card, your address, and your telephone number. You should also send any information that helps explain your problem.

Mail the form or your letter to:

Aetna Better Health of Ohio

c/o OhioRISE Plan

Appeal and Grievance Department

PO Box 81139

5801 Postal Road

Cleveland, OH 44181

Fax: 1-833-928-1259

OhioRISE will send you something in writing if we decide to:

• Deny a request to cover a service for you,

• Reduce, suspend, or stop services before you receive all the services that were approved, or

• Deny payment for a service you received that is not covered by OhioRISE.

We will also send you something in writing if we did not:

• Decide on whether to cover a service requested for you, or give you an answer to something you told us you were unhappy about.        

Gian lận, Lãng phí và Lạm dụng

Healthcare fraud, waste and abuse affects everyone. Combating it begins with awareness.

Fraud is committed when a dishonest provider or consumer intentionally submits, or causes someone else to submit, false or misleading information for use in determining the amount of health care benefits.

Waste is the over-utilization of services not caused by criminally negligent actions and the misuse of resources. 

Abuse is provider practices that are inconsistent with professional standards of care: medical necessity, or sound fiscal, business, or medical practices and provider or beneficiary practices that result in unnecessary costs to the healthcare program.

What is provider fraud, waste and abuse?

• Billing for services not rendered
• Upcoding (billing for more expensive services or procedures than were actually provided or performed)
• Soliciting, offering or receiving kickbacks
• Improper or sloppy billing practices
• Failure to maintain adequate records
• Routine waiver of coinsurance and deductible

What is member fraud, waste and abuse?

• Loaning or using another person's insurance card
• Forging or selling prescription drugs
• Providing false information when applying for program benefits

UnitedHealthcare Community Plan is committed to combating fraud, waste and abuse. If you suspect health care fraud, waste and abuse, you may report via the following methods:

• Anonymous fraud, waste and abuse hotline: 1-877-766-3844