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. and UnitedHealthcare of Oregon, Inc. currently contracts with and the services they perform:

  • eviCore Healthcare MSI, LLC dba eviCore Healthcare provides clinical prior authorizations for radiology and cardiology services
  • United Behavioral Health provides clinical prior authorizations for behavioral health services, including claim delegation
  • OptumHealth Care Solutions, LLC provides clinical prior authorizations for physical therapy, occupational therapy, speech therapy and chiropractic care services, transplant services and cancer related services, including claim delegation
  • OptumRx, Inc. provides clinical prior authorizations for prescription drug services
  • OrthoNet LLC provides clinical prior authorizations for orthopedic services
  • Dental Benefit Providers, Inc. provides clinical prior authorizations for dental services, including claims adjudication. Additionally, Dental Benefit Providers, Inc. provides provider network management for UnitedHealthcare Insurance Company. Dental Benefit Providers, Inc. is not an HCBM for UnitedHealthcare of Oregon.
  • United HealthCare Services, Inc. (UHS) provides health benefit programs, utilization review services, and performs clinical prior authorizations for hospital, medical, and other health services to its employer groups and participating members
  • Spectera, Inc performs claims adjudication for vision services