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Network Management
The Funds strives to provide its beneficiaries with easy access to top quality, cost-effective healthcare. To ensure high quality care, control costs, and maximize provider and beneficiary relations, the Funds has developed provider networks.
The Funds currently has several operational provider networks:
- Cooperating Funds Providers
- Cooperating Funds Providers are providers who accept the Funds' payment as payment in full and agree not to balance bill beneficiaries for covered services.
The 14,000 Cooperating Funds Providers represent a full range of providers including primary care physicians, specialty physicians, hospitals, skilled nursing facilities, and home health care agencies. Cooperating Funds Providers are listed in the Cooperating Funds Provider Directory. The Directory is available in hard copy and on the Internet. Beneficiaries are encouraged to use the Directory to select providers who cooperate with the Funds. Providers may use the information when referring patients. The Field Service Offices can also help beneficiaries or providers to select Cooperating Funds Providers.
Providers may find it advantageous to sign a Cooperating Funds Provider Agreement contract. Besides agreeing to accept the Funds' payment level, these providers are permitted to inform the general public and Funds beneficiaries that they are a "Cooperating Funds Provider" in its marketing materials approved by the Funds.
Beneficiaries have the choice of using network or non-network providers.
If you would like more information about the Cooperating Funds Provider Network, please contact Barbara Barris at GJames@umwafunds.org.
- Durable Medical Equipment Network
- The Durable Medical Equipment (DME) Network consists of the following eight vendors who offer both local and national service through direct service or sub-networks to the majority of Funds' beneficiaries:
- American Home Patient
- Appalachian Regional Healthcare Services, Inc.
- Community Home Care Services, Inc.
- Cooley Medical Equipment
- Home Care Alliance of Virginia
- Home Health Care Services, Inc.
- Medical Services of America. Store name - Medi Home Care
- Progressive Medical
The DME Network is exclusive for DME equipment only, as defined as any service billed under HCPCS codes E0100 through E9999 and K0001 through K0109. All equipment must be purchased from one of these eight providers. DME services while a patient is in a hospital, nursing home, or rehabilitation facility are not subject to the program.
Beneficiaries are not limited to the Network when obtaining medical supplies such as diabetic and incontinent supplies or other services such as Home Health Care or IV Infusion.
Network Access
Providers may call either the Field Service Office on your patient's Funds' membership card or National Health Services at 1-800-292-2288 for help in locating an appropriate DME Network vendor. You may also access the Durable Medical Equipment Database directly to search for Network DME vendors based on a patient's zip code.
- Primary Care Physician Demonstration Networks
- Special Primary Care Physician (PCP) Demonstration Networks are currently located in southwestern Pennsylvania, central and eastern West Virginia, and Birmingham, Alabama. To view the network directory, click here. These networks are a part of a special health demonstration that the Funds operates in conjunction with Medicare.
The Special PCP Demonstration Network Physician is responsible for providing, coordinating, and managing the health care services for enrolled Funds beneficiaries. He or she provides and coordinates all health care services and directs beneficiaries to appropriate specialists and hospitals as required.
Special PCP Demonstration Network physicians may also participate in special Funds disease management projects as well as steering committees that help the Funds manage care appropriately.
Special PCP Demonstration Network physicians agree to accept Funds' payments as payment in full. They do not balance bill beneficiaries for covered services.
Beneficiaries have the choice of using network or non-network physicians.
Who can become a Special Primary Care Demonstration Network Physician?
Special PCP Demonstration Network physicians are local primary care doctors in the three demonstration areas. Network physicians include family and general practitioners, geriatricians, internists, and some specialists such as cardiologists who agree to take responsibility for a beneficiary's primary and preventative care. If you would like more information about physician enrollment, please contact the Funds at the Washington Field Service Office at 1-800-403-3347.
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