The claims mailing address is:
UMWA Funds
PO Box 211551
Eagan, MN 55121-2751
The Funds has a long-standing relationship with the Medicare program as a Health Care Prepayment Plan (HCPP) and is the Medicare payer for non- facility Part B services, such as physician, laboratory, and ambulance services and medical equipment and supplies. You must bill the Funds for Medicare Part B services. Medicare carriers will not pay for Part B services provided to Funds’ beneficiaries. The Funds payment to the provider will include the Medicare amount plus the Medicare coinsurance and deductible amount, making it unnecessary for the provider to submit claims to two payers.
Health care providers should bill charges for Medicare Part A services and other services normally paid by the Medicare fiscal intermediary directly to the intermediary as they would for patients without Funds’ benefits. After payment by the fiscal intermediary the provider may bill the Funds for Medicare coinsurance and deductibles.
The telephone number for pre-authorization is 1-800-292-2288, option #3.
No referral is required for The Funds’ Plans.
Yes, the prescription benefits are administered by CVS Caremark at 1-800-294-4741.
Yes, the Funds follows CMS’s guidelines related to Nurse Practitioners and Physician Assistants.
The timely filing is 12 months from the date of service for claims (21 months prior to 1/1/2011). An appeal of a denied claim must be filed within 180 days of the date of denial.
The address for purposes of submitting an appeal is
UMWA Health and Retirement Funds
PO Box 292167
Nashville, TN 37229
Click the link below for information about electronic claims submission through CareVu/HealthSmart:
http://www.healthsmart.com/InformationSystems/EDIClearinghouse.aspx
The electronic payer ID number is 52180.
Click the Link below for information about electronic claims submission through CareVu/HealthSmart:
http://www.healthsmart.com/InformationSystems/EDIClearinghouse.aspx
