EXCELLENCE THROUGH QUALITY


  IMPORTANT

 

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        1. 1.  Referral Submissions are limited to PCPs only, and for participating specialist office visits only (E&M codes). No other codes are accepted in the Referral Submission Form.
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                  ****PLEASE NOTE:  ADDRESS FOR CLAIMS HAS CHANGED

 

                  The address to submit paper claims is:

                             Physicians United Plan
                             Attn: Claims
                             8427 SouthPark Circle, Ste 500
                             Orlando, FL 32819


EDI Claims Submissions are accepted through Availity - 10775 or through Emdeon - TH131 
(which are routed through Availity).

 

 
 
 
LATEST NEWS

 All Providers - both PCPs and Specialists, can now submit Authorizations via EZNet.  PCPs can also submit Referrals via EZNet.  Please contact your PR Rep for an inservice if you have any questions regarding how to use EZNet.

   

HEALTH PLAN
Your local Provider Representative is available to serve participating providers! Call your representative with comments or questions or to request an in-service:

      - Broward & Miami – Dade Counties = Carlos Gill (954) 789-5680
      - Hillsborough, Pasco, & Pinellas Counties = Beth Baertschi (813) 480-6134
      - Lake & Sumter Counties = Amanda King (352) 278-7433
      - Marion County = Lauren Halvorson (352) 262-9660
      - Orange County = Kathy Markoe (407) 450-6597
      - Osceola & Seminole Counties = Marlen Almodovar (407) 473-8628
      - Polk County = Carlos Benitez (407) 205-6682
      - Palm Beach County = Angela Rodriguez (561) 398-0484
      - All Other Counties = Network Operations (866) 427-9152



EXCLUSIVE SERVICE PROVIDERS

In an effort to provide quality service to our members, PUP has made arrangements with limited providers in various specialties. If a PUP Member requires the following services, please contact vendor:


·         For Behavioral Services contact PsychCare at 888-624-0787

·         For Optometry and Ophthalmology Services contact Advantica Vision at 888-787-8476

·         For Dental Services contact Advantica Dental at 866-363-7678

·         For Audiology Services contact HearUSA at 800-333-3389; or contact an audiology provider directly

·         For DME Supplies, Home Health and Infusion Therapy call Univita Healthcare Solutions at 855-914-2201


         The following services ARE NOT provided by Univita.  Please see 
           PUP Provider Directory to call participating provider directly:

    ·        Custom mobility

    ·        Diabetic supplies

    ·        Lymphedema pumps/pneumatic compressor and appliances

    ·        Mastectomy supplies

    ·        Orthotics & Prosthetics

    ·        Ostomy supplies


Quality Management Provider

For Ultrasound, Advanced Imaging, Cardiac Imaging, Sleep, Radiation Therapy, Cardiac Rhythm Devices (CRD), Lumbar Spine Surgery use  MedSolutions – Prior authorization applies to services that are: Outpatient, Elective / Non-emergent, Diagnostic. Prior authorization does not apply to services that are performed in: Emergency Room, Inpatient, 23-hour observation.

 

MedSolutions, Inc. (see provider page of PUP website for list of service effective dates)

You can contact MedSolutions in one of three ways:

·         Internet:  www.medsolutionsonline.com (registration required; web portal training available!)

·         Phone:  800-572-2058 (8:00am-9:00pm EST Monday - Friday)

·         Fax:  1-855-881-6737 for radiation oncology requests

·         Fax:  1-855-702-2289 for all other requests


(Fax forms available online or by calling customer service; only MedSolutions fax forms will be accepted)


It is the responsibility of the ordering provider to request prior authorization approval for services.  To find a list of CPT (Current Procedural Terminology) codes that require prior authorization through MedSolutions, please visit:
http://www.medsolutions.com/implementation/pup


To Register: 
https://www.medsolutionsonline.com/portal/server.pt/community/msi_customers/204/provider_registration

 

 



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