Learn how to use our new CareAdvance tool under the Request Authorization tab. Expand the appropriate service type category to locate our CareAdvance Provider navigation guide, WebEx and tip sheet. Please click here to access FAQ's Open a PDF.
If you receive an error message stating "You have no associated provider sets", we can help you;
please email your Web Username and Individual or Group NPI to CAPAdministratorUnivera@univerahealthcare.com to update the system.
If you have any questions, please contact your Provider Relations Representative.
Authorizations
The medical services including provider administered drugs below require prior review by the plan to determine clinical medical necessity.
Referral & Authorization Guidelines
- Medical Prior Authorization Code List - August 1, 2020Open a PDF
- Medical Prior Authorization Code List - June 1, 2020Open a PDF
- DME Prior Authorization List - August 1, 2020Open a PDF
- DME Prior Authorization List - June 1, 2020Open a PDF
- UM Initial Determination Timeframes - Commercial ProductsOpen a PDF
- UM Initial Determination Timeframes - Medicare ProductsOpen a PDF
- UM Initial Determination Timeframes - Medicaid & Safety Net ProductsOpen a PDF
- Behavioral Health Prior Authorization Guidelines Code List Effective July 1, 2019Open a PDF
- eviCore Codes Requiring Preauthorization - Master GridOpen a PDF
- Medical Specialty Drug (For Commercial, Exchange, and Medicare)Open a PDF
Univera Healthcare MyHealthSM, Child Health Plus and MyHealth PlusSM
- Inpatient Prior Authorization FormOpen a PDF
- Outpatient Prior Authorization FormOpen a PDF
- Adult Behavioral Health Home and Community Based Services Prior/Continuing Authorization FormOpen a PDF
- Behavioral Health Outpatient Treatment Request FormOpen a PDF
- Inpatient and Outpatient Neuropsychological and Psychological Testing Authorization FormOpen a PDF
- Behavioral Health Prior Authorization Guidelines Code List Effective July 1, 2019Open a PDF
- Medical Specialty Drug (For Medicaid, Safety Net, and Essential Plan)Open a PDF
