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Oxford Contact Overview Contact Infor mation at a Glance . . . . . . . . 9
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www.oxfordhealth.com
Oxford Contact Overview — Section 1
Contact Information at a Glance
• Submit referrals • Check the status of claims and request copies of remittance advices
Electronic Solutions
Electronic Data Interchange (EDI) www.oxfordhealth.com To access Oxford’s web site, please go to www.oxfordhealth.com. To log in to www.oxfordhealth.com, you will need a user name and password. If you do not have a user name and password, please click on “need a user name and password”, fill in the required information and submit your request. Providers should have immediate access; facilities will receive a user name and password by telephone within two to three business days. From the provider or facility home page, you can perform the following transactions: • Submit and check referrals, claims and precertification requests
Oxford works with various EDI vendors to give our providers an additional option to do electronic business. The EDI vendors and their functions are: WebMD® • Check patient eligibility • Submit referrals and precertification requests • Check the status of referrals and precertification requests • Submit electronic claims ProxyMed • Check patient eligibility • Submit referrals
• Submit notification of inpatient admissions (facilities only)
• Check the status of referrals
• Check patient benefits and eligibility
• Check claims status
• Change your address
• Submit electronic claims
• Request materials
Healthcare Data Exchange (HDX)
• Perform a provider search
• Check patient eligibility
• Learn about new business arrangements
• Check the status of precertification requests
• View radiology, physical therapy and laboratory program information
• Submit electronic claims
• View Oxford’s drug formulary • View Oxford’s medical and administrative payment policies
Athena • Check patient eligibility • Check claims status
• View Oxford’s Clinical and Preventive Practice Guidelines
• Submit electronic claims
• View Oxford’s disease management initiatives
Addresses, Telephone and Fax Numbers
Oxford Express® (1-800-666-1353) Use our automated telephone system to: • Check patient eligibility
To access Oxford’s Provider Services, which includes Medical Management services, please call 1-800-666-1353 (Mon. - Fri., 8 AM - 6 PM).
• Check the status of referrals and precertification requests
www.oxfordhealth.com
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Section 1 — Oxford Contact Overview
Medical Management
Services and Resources Contact Information
Call for Precertification
Behavioral Health Services — Oxford 1-800-201-6991 (for precertification only)
• Inpatient admissions • Outpatient procedures See section 6 on Ancillary Services for details on precertification for alternative medicine, physical therapy, radiology, or behavioral health; or see section 4 on Precertification for more information.
Fax
1-800-760-4041
Chiropractic Services — TRIAD Healthcare, Inc. (network services, utilization management and claims inquiry) Fax for authorization
1-800-409-9081
1-866-225-1033
Oxford On-Call ®
Clinical Appeals Department fax
Oxford On-Call is our 24-hour telephone triage service for Members. Under the direction of a Medical Director, and based on clinical guidelines, an Oxford On-Call nurse poses a series of questions regarding the Member’s symptoms. Based on the Member’s responses, the nurse suggests a plan of care, which may include advising the Member to consult with or make an appointment to see his or her primary care physician (PCP) or, in some situations, a specialist, to seek care at an urgent care center or emergency room, or to follow self-care suggestions. If the Member’s PCP is unavailable, a specialty referral may be made for the Member when clinically appropriate.
Complementary & Alternative Medicine fax (care plans)
1-800-201-7025
Electronic Solutions Support
1-800-599-4334
Oxford On-Call always attempts to connect patients with their PCPs. Because Oxford supports the central role of the Member’s physician, we always remind the Member of the importance of calling his or her PCP first and of returning to the PCP’s office for any needed follow-up or preventive care. We view our Oxford On-Call service as a supplement to the PCP, not as a replacement. One of the common scenarios in which a Member will call us is when a medical problem occurs while far away from home. Oxford On-Call is happy to assist Oxford participating physicians with urgent referrals, obtaining after-hours home care or medical equipment. Providers who need assistance may call Oxford On-Call at 1-800-201-4911. PCPs are faxed a transcript of every triage episode involving their patient, provided the Member gives us permission to do so. The transcript includes the Member identification information, the questions asked by the Oxford On-Call nurse, the Member’s answers, and any additional comments. The fax also includes any guidance given by the nurse. If the Member is referred to a specialist, both the PCP and the specialist will receive a faxed copy of the referral.
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203-459-5423
Laboratory information — Quest Diagnostics Incorporated Client services: New Jersey
1-800-631-1390
Long Island, New York
1-800-877-7530
All other New York
1-800-631-1390
Connecticut
1-800-982-6810
Patient Service Center Locator 1-800-377-8448 or www.questdiagnostics.com See section 6 on Ancillary Services for a complete list of outpatient laboratories. Medicare Appeals Department fax
203-459-5486
Pharmacy Customer Service — Medco Health Solutions, Inc. (Medco) 1-800-905-0201 Pharmacy precertification 1-800-753-2851 (Mon. - Fri., 8 AM - 9 PM Eastern Standard Time) Physical and Occupational Therapy — OrthoNet Provider services/claim inquiry 1-800-201-4891 Medical management
1-800-201-4872
Precertification by fax
1-800-216-0810
Radiology information — CareCore National, LLC 1-877-PREAUTH (commercial and Medicare radiology)(1-877-773-2884)
www.oxfordhealth.com
Oxford Contact Overview — Section 1
Oxford Medicare Advantage® Services Contact Information Montefiore-CMO arrangement for Oxford Medicare Advantage Members in Bronx County Medical management/provider services, claim information
If mailing in an initial paper claim using the CMS-1500 or UB-92 form, please send the claim to the appropriate address below within 180 days of rendering services:
O
OX F O R D
1-800-876-7455
Referral fax number
914-467-4362
Coordinated Care Solutions (CCS) [for Oxford Medicare Advantage Members who reside in Kings County (Brooklyn) — for post-acute services only]
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I M PO R TA N T A D D R E S S E S
Commercial Claims Oxford Health Plans P.O. Box 7082 Bridgeport, CT 06601-7082 Oxford Medicare Advantage Claims
Medical management (skilled nursing, home healthcare, durable medical equipment, and reauthorization of home healthcare) 1-888-496-1283
Oxford Health Plans P.O. Box 7086 Bridgeport, CT 06601-7086
Fax numbers for authorizations:
Montefiore-CMO Claims
Skilled nursing and home healthcare 1-866-506-2369 Sub acute inpatient services
212-324-6514
Durable medical equipment
1-888-498-9212
Provider services
1-888-721-9797 ext. 63728
Claims Submission Addresses All claims should be submitted electronically through one of the clearinghouses that Oxford works with. Electronic claims should be submitted with Oxford’s Payor ID: 06111. For more information on submitting electronic claims, please call Oxford’s Provider eSolutions Support Team at 1-800-599-4334.
Providers participating in a delegated risk agreement for Oxford Medicare Advantage in Bronx County should submit claims to: Contract Management Organization, LLC Attn: Oxford Claims Department 200 Corporate Drive Yonkers, NY 10701 Coordinated Care Solutions (CCS) Claims Oxford Medicare Advantage Members residing in Kings County (Brooklyn), New York should submit claims to: Oxford Health Plans P.O. Box 7086 Bridgeport, CT 06601-7086 Hand Delivered Claims or by Certified/Registered Mail* Oxford Health Plans Attn: Intake Imaging 7120 Main Street Trumbull, CT 06611 * Applies for New Jersey providers only
See section 8 on Claims for more information.
www.oxfordhealth.com
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Section 1 — Oxford Contact Overview
Contact Information for Disease and Intensive Case Management Programs Please use the telephone number listed below to contact the specific program coordinator. Active Care EngagementSM (ACE)
1-877-759-3059
Better Breathing ® (asthma)
1-800-665-4686
Depression Program
1-800-665-4686
Heart Smart programs: SM
Cardiovascular Disease
1-800-665-4686
Congestive Heart Failure
1-800-665-4686
HIV/AIDS
1-888-585-0629
Living with Diabetes SM
1-800-665-4686
Lyme Program
1-888-585-0629
Newborn Critical Care
1-888-201-4259
Rare Chronic Care Program
1-800-948-2497
Transplant Program
1-888-201-4257
New York State New York State and New York City information
1-800-541-2437
New York State Spanish/ bi-lingual information
1-800-233-7432
New York State TTY/TDD (for hearing-impaired)
1-800-369-2437
New York City Department of Health testing hotline
1-800-825-5448
Pretesting counseling is conducted over the phone, and appointments are made for callers at testing centers throughout the five boroughs. This service is linked to a crisis intervention hotline.
Information on Anonymous Counseling and HIV Testing Programs Centers for Disease Control (CDC) National AIDS Hotline
1-800-342-2437
Connecticut CT Infoline
1-800-203-1234
This number is only accessible when calling from Connecticut and provides referrals to all state and local hotlines and resources. New Jersey
1-800-624-2377
Available 24 hours, seven days a week, this number is only accessible when calling from New Jersey. New Jersey local number
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973-926-7443
www.oxfordhealth.com
