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Preauthorization Updates Effective May 1, 2022 for All Lines of Business Requiring Preauthorization

Audience: All Providers

We would like to share updates regarding preauthorization under our Utilization Management (UM) Program. The UM Program gives Univera Healthcare and its health care provider partners the opportunity to monitor medical episodes of care to prevent unnecessary treatment...

AP-42 – Developmental and Psychological Testing Policy Effective March 1

Audience: Professional Providers

Univera Healthcare is implementing the following administrative policy effective March 1, 2022 to define coverage and billing guidelines for developmental and psychological testing billed by providers contracted to provide this service. You can access the individual...

Utilization Management Updates for Cardiology Imaging Services Only

Audience: Cardiologists and Radiologists

We would like to make you aware of a delay in the effective date for utilization management updates for cardiology imaging services.  In our communication dated October 28, 2021, we shared an effective date of February 1, 2022; that implementation is on pause for...

Information Related to NYS DFS Insurance Circular Letter No. 1 (2022)

Audience: Hospitals and Skilled Nursing Facilities

Univera Healthcare has implemented the requirements included in the New York State Department of Financial Services’ (NYS DFS) Insurance Circular Letter No. 1 (2022) issued January 6, 2022, for its commercial and Safety Net lines of business. In addition, Univera...

Assisted Reproductive Technologies – In Vitro Fertilization Medical Policy Update Effective April 14, 2022

Audience: OB/GYNs and Endocrinologists

Univera Healthcare works to ensure that the development of corporate medical policies occurs through an open, collaborative process. We encourage participating providers to become actively involved in medical policy development. Each month, draft policies are available on...

New Clinical Editing Policy Effective April 1, 2022

Audience: All Professional Providers

Univera Healthcare is implementing a clinical editing policy effective April 1, 2022, which will no longer provide reimbursement for codes that have a Centers for Medicare and Medicaid Services (CMS) status indicator. The policy, which is in line with CMS rules, only...

Discontinuation of Paper Notification for Claim Billing Errors

Audience: Participating Physicians and other Health Care Practitioners

Effective February 4, 2022, Univera Healthcare will discontinue its practice of sending paper notification when certain billing errors occur. This change is part of our overall effort to reduce the amount of paper sent to provider practices.  Billing errors...

Telehealth Payment Parity Update

Audience: All Participating Providers

With the pandemic still a reality in our day-to-day lives, we want our members to have the peace of mind that comes from knowing they can still receive care in the comfort and safety of their homes through the use of telehealth technology. We also know how important it...

Holiday Office Closure and Zelis® Payments Schedule Update

Audience: Participating Providers and Facilities

Univera Healthcare offices will be closed on December 24, 2021. There will be no pay cycle schedule changes for InstaMed®. There will be delays in the transmission of paper checks issued by Zelis Payments. Please allow for delivery time via the U.S. Postal Service. For...

Clinical Editing Reminder: Multiple Procedure Payment Reduction Rules

Audience: Participating Providers

Univera Healthcare follows the Centers for Medicare and Medicaid Services (CMS) Multiple Procedure Payment Reduction rules for all lines of business. When multiple surgeries or procedures are performed by a single physician, or when physicians in the same group practice...

New Radiation Oncology Medical Policy Effective March 15, 2022

Audience: Radiologists and OB/GYNs

Univera Healthcare works to ensure that the development of corporate medical policies occurs through an open, collaborative process. We encourage participating providers to become actively involved in medical policy development. Each month, draft policies are available...

Update to Radiation Oncology Medical Policy Effective March 15, 2022

Audience: Participating Oncologists: Radiation, Medical, and Surgical

Univera Healthcare works to ensure that the development of corporate medical policies occurs through an open, collaborative process. We encourage participating providers to become actively involved in medical policy development. Each month, draft policies are available on...

Updated Participating Provider Manual Now Available

Audience: Participating Physicians, Health Care Practitioners and Facilities

The Univera Healthcare Participating Provider Manual has been updated and is now available on our website. You will need to log in to the secure portion of the website to view the manual. Once logged in, you now have the option to view the entire manual or the individual...

2022 Authorization Requests

Audience: Physical, Occupational, and Speech Therapists and Home Care Providers

New authorization requests for physical, occupational, speech and home care services in 2022 can be entered into the CareAdvance Provider® tool beginning December 20, 2021. Please share this information with anyone in your practice who needs to be aware. If you have...

Submission of Claims Requiring Medical Records

Audience: All Providers

In accordance with standard medical record submission procedures, Univera Healthcare requires medical records related to certain services be filed with the initial claim. Effective March 15, 2022, we will begin returning records related to these specific services that are...

Showing 1– 15 of 100 Results
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