2017 Provider Manual Table of Contents

Introduction

For over three decades Universal Care, Inc. (d.b.a. Brand New Day) has been dedicated to providing affordable quality health care. Brand New Day is a Medicare Advantage Health Plan, which includes contracted physicians in a network of health care professionals that are committed to the concept of comprehensive quality health care. Brand New Day is the product name of Universal Care’s program contracted with the Centers for Medicare and Medicaid Services (CMS). As a Medicare Advantage Plan with multiple “Chronic Care Special Needs Plans” (CSNP) for eligible Medicare beneficiaries diagnosed with a serious and persistent mental illness (SPMI), Diabetes, Congestive Heart Failure (CHF), Dementia and those with Dual insurance coverage (Medi-Cal and Medicare).

Brand New Day recognizes that timely and appropriate access to specialty physician care, as managed through a network of skilled Primary Care Physicians (PCPs) in conjunction with assigned Specialty Providers, yields both high quality and cost-effective care. This philosophy is enhanced by the active involvement of medical Case Managers (CMs), Clinical Program Directors (CPD’s) Health Coaches (RN’s, LVN’s and MA’s) and behavioral health Life Coaches (LC’s) who are assigned to ensure that each member receives encouragement in the areas related to the seven fundamentals of health- education, nutrition, exercise, monitoring and testing, medication adherence, preventive care, and community linkages. Brand New Day members who enroll with our behavior health plan for Serious and persistent mental illness have access to a Wellness Centers, which provide a setting for socialization and personal growth, through individual and group therapy. Ultimately, the combination of these services lead to a decrease in costly medical treatment and procedures and an increased quality of life for members.

Brand New Day’s systems are designed to complement and comply with state and federal laws and the regulations of the Centers for Medicare and Medicaid Services (CMS). Brand New Day provides an orientation to service and non-duplication of administrative functions between the Health Plan and Contracted Providers to control costs. These features, combined with member access and convenience, enable Brand New Day to provide for its members, “A Brand New Day” with renewed hope for a bright future.

This manual is a tool to assist you in providing contracted health care services to the members of Brand New Day. Since Brand New Day is a health care delivery system, it is important to understand that our essential responsibility is to provide comprehensive managed care to all members. While it is true that members will look to your providers for some of their health care needs, they will also seek assistance from others in the Brand New Day provider network to assist them with obtaining other benefits.

The Contracted Provider health plan coordinator plays an integral part in understanding, implementing and monitoring the integration of Brand New Day members into your medical office. Primary responsibilities of the person in that role should be to ensure patients’ questions are answered in an effective and efficient manner and that policies and procedures set forth herein are adhered to.

Finally, the purpose of this manual is to provide direction and guidance regarding the basic operational processes of Brand New Day. Contracted Providers are responsible for distributing copies of the Provider Manual to their Participating Providers.

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