Health Care Benefit Managers

UnitedHealthcare may contract with others to help us in managing your health plan benefits. These entities are called Health Care Benefit Managers. Health Care Benefit Manager means a person or entity providing services to, or acting on behalf of, a health insurance carrier or employee benefits programs, that directly or indirectly impacts the determination or utilization of benefits for, or patient access to, health care services, drugs, and supplies including, but not limited to:

Prior authorization
Certification of benefits or care / medical necessity determinations
Utilization review (concurrent review / retro review)
Benefit determinations
Claims processing
Claim repricing for services and procedures
Outcome management / disease management
Provider credentialing and recredentialing
Appeals processing

Following is a list of Health Care Benefit Managers that UnitedHealthcare Insurance Company, UnitedHealthcare of Washington, Inc., UnitedHealthcare of Oregon, Inc. Golden Rule Insurance Company, The Chesapeake Life Insurance Company and Mid-West National Life Insurance Company of Tennessee currently contracts with and the services they perform:

HCBM	Services Provided	Entities
eviCore Healthcare MSI, LLC dba eviCore Healthcare	Clinical prior authorizations for radiology and cardiology services	UnitedHealthcare Insurance Company, UnitedHealthcare of Oregon, UnitedHealthcare of Washington
United Behavioral Health	Provider Network Management, Credentialing and Recredentialing, Utilization Review and Claims Processing and repricing for services and procedures	UnitedHealthcare Insurance Company, UnitedHealthcare of Oregon, UnitedHealthcare of Washington
OptumHealth Care Solutions, LLC	Provider Network Management, Utilization Review, and Disease Management	UnitedHealthcare Insurance Company, UnitedHealthcare of Oregon, UnitedHealthcare of Washington
OptumRx, Inc.	Provider Network Management, Credentialing and Recredentialing, Utilization Review, Clinical prior authorizations for prescription drug services, and Claims Processing for services and procedures	UnitedHealthcare Insurance Company, UnitedHealthcare of Oregon, UnitedHealthcare of Washington
Dental Benefit Providers, Inc.	Provider Network Management, Credentialing and Recredentialing, Utilization Review and Claims Processing and repricing for services and procedures	UnitedHealthcare Insurance Company, UnitedHealthcare of Washington, Golden Rule Insurance Company
UnitedHealthcare Services, Inc.	Prior Authorization or Preauthorization of Benefits or Care and Utilization Review	UnitedHealthcare Insurance Company, UnitedHealthcare of Oregon, UnitedHealthcare of Washington
Spectera, Inc.	Provider Network Management, Credentialing and Recredentialing, Claims Processing and repricing for services and procedures	UnitedHealthcare Insurance Company, UnitedHealthcare of Oregon, UnitedHealthcare of Washington, Golden Rule Insurance Company
Core V Solutions, Inc. (dba Careington Benefit Solutions)	Provider Network Management, Claim Processing for Services and Procedures (including appeals processing), and Provider Credentialing and Recredentialing	The Chesapeake Life Insurance Company, Golden Rule Insurance Company, Mid-West National Life Insurance Company of Tennessee, UnitedHealthcare of Washington, and UnitedHealthcare Insurance Company
EyeMed Vision Care, LLC and First American Administrators, Inc.	Provider Network Management, Claims processing, claim repricing for services and procedures, and provider credentialing and recredentialing and appeals processing for vision services	The Chesapeake Life Insurance Company, Mid-West National Life Insurance Company of Tennessee
OrthoNet, LLC	Clinical prior authorizations for orthopedic services	UnitedHealthcare Insurance Company, UnitedHealthcare of Oregon, UnitedHealthcare of Washington
DenteMax, LLC	Provider Network Management	UnitedHealthcare Insurance Company, UnitedHealthcare of Washington, Golden Rule Insurance Company
Government Employees Health Association, Inc.	Provider Network Management	UnitedHealthcare Insurance Company, UnitedHealthcare of Washington, Golden Rule Insurance Company
United Concordia Companies, Inc.	Provider Network Management	UnitedHealthcare Insurance Company, UnitedHealthcare of Washington, Golden Rule Insurance Company
P&R Dental Strategies, LLC	Medical Necessity Determinations, Utilization Review	UnitedHealthcare Insurance Company, UnitedHealthcare of Washington, Golden Rule Insurance Company
Dental Health Alliance, LLC	Provider Network Management	UnitedHealthcare Insurance Company, UnitedHealthcare of Oregon, UnitedHealthcare of Washington