U.R.N. provides an extranet site, www.urnclient.com that contains the detailed quantitative and qualitative information collected during the network credentialing process. The site also contains contract information for each participating provider, maps for each U.R.N. network, referrals submitted to U.R.N., and the status of claims repricing for individuals referred for services through U.R.N. Many of the transplant contracts are negotiated based on “phases” of transplant. Below are the definitions of the phases:
|Phase I Pre-Transplant Evaluation||All health services required to access and evaluate a member for acceptance into a transplant program. Phase I ends upon the member’s listing with United Network for Organ Sharing (UNOS). For living donor organ transplants or organ transplants not listed with UNOS, Phase I ends upon the member’s acceptance into a transplant program.|
|Phase II Pre-Transplant Care||All health services provided to a member following acceptance into a transplant program, or listing with UNOS, and before the admission for the authorized transplant.|
|Phase III Transplant Procedure||All health services provided to a member from the day of admission for the authorized transplant until the earlier of the member’s discharge from the transplant facility following the transplant admission or transfer to transplant facility’s inpatient rehabilitation unit or facility.|
|Phase IV Follow-up Care||All health services provided to a member during the 90 day period immediately following Phase III.|
|Phase V Post Phase IV Health Services||All health services provided to a member during the one-year period immediately following Phase IV.|
During the month following each quarter, U.R.N. compiles a client network activity summary report reviewing all referrals received for transplants for that quarter. The status of the referrals and claims payments, access fees paid, and cost savings are included in the report. The report is forwarded to all Summit Re clients accessing U.R.N. through Summit Re. If you have any questions about the reports you receive, please contact Debbie Stubbs RN, MS, CCM at dstubbs@Summit-Re.com or Kari Lee at kari.lee@UHC.com.