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Change in Pharmacy Benefit for Medicaid Managed Care Members
Audience: Durable Medical Equipment ProvidersAs you may know, effective April 1, 2023, pharmacy benefits for Medicaid Managed Care and Health and Recovery Plan (HARP) members are covered under Medicaid Fee for Service (NYRx) and not by Univera Healthcare. Effective April 1, you must bill NYRx directly for these...
HIV-Experienced Provider Identification
Audience: Physicians, Nurse Practitioners and Physician AssistantsUnivera Healthcare is required by the New York State Department of Health to identify participating practitioners who have experience treating HIV/AIDS patients and to make this information available to members in our provider directory. An HIV-experienced practitioner...
Medicaid Enrollment Requirement Update
Audience: Licensed Clinical Social Workers, Licensed Mental Health Counselors and Licensed Marriage and Family TherapistsSection 5005 of the 21st Century Cures act requires Managed Care Organizations (MCOs) to ensure all eligible Medicaid Managed Care (MMC) and Child Health Plus (CHP) network providers are enrolled with the New York State Fee-for-Service Medicaid program. Per information...
Medicare Part D Vaccine Billing Requirement Update
Audience: Internal Medicine and Family Practice Physicians and Nurse PractitionersWe remind you that effective February 1, 2023, Univera Healthcare will require the use of the TransactRx billing tool when Medicare Part D vaccines are administered in your office to Medicare Advantage members. You were notified of this update in our bulletin issued...
Xgeva® Prior Authorization Updates Effective April 1, 2023
Audience: Participating Hematologists, Oncologists, and RadiologistsWe would like to provide advance notice regarding prior authorization requirements for Xgeva® when billed under the member’s medical benefit. These updates are effective April 1, 2023 and apply to all lines of business. Please follow the requirements outlined...
Ambulatory Event Monitor Medical Policy Update Effective March 15, 2023
Audience: Participating Cardiologists, Electrophysiologists, and NeurologistsUnivera Healthcare (“Health Plan”) 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...
Stereotactic Radiosurgery and Stereotactic Body Radiotherapy Medical Policy Update Effective March 15, 2023
Audience: Participating OncologistsUnivera Healthcare (“Health Plan”) 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...
CareAdvance Authorization Request – Requesting Provider Requirements
Audience: Physical, Occupational and Speech Therapists and Home Care ProvidersWe would like to make you aware of an important requirement change regarding the CareAdvance Provider (CAP) online authorization tool. Effective immediately, new authorizations requests entered into CAP must include an individual provider name as the...
Environmental Modifications, Vehicle Modifications, Assistive Technology, and Palliative Care Preauthorization Process Changes
Audience: Health Home Care Management Agencies and Project ManagersWe would like to share a change in our preauthorization process effective January 1, 2023, for environmental modifications, vehicle modifications, assistive technology and palliative care. This new process will be more efficient in managing requests to ensure that members...
New Benefit: Gambling Disorder Treatment Services effective January 1, 2023
Audience: NYS Office of Addiction Services and Supports (OASAS) FacilitiesEffective January 1, 2023, gambling disorder treatment services provided by OASAS certified programs will be covered for members enrolled in Medicaid Managed Care. This applies to members with Univera Healthcare MyHealthSM and MyHealth PlusSM coverage. Services can be...
Applied Behavioral Analysis Services Transitioning to Medicaid Managed Care effective January 1, 2023
Audience: Applied Behavioral Analysis ProvidersOn January 1, 2023, Applied Behavioral Analysis (ABA) services will transition to Medicaid Managed Care (MMC) for children/youth under the age of 21 with a diagnosis of Autism Spectrum disorder and/or Rett Syndrome enrolled in Univera Healthcare MyHealthSM coverage. The...
Prior Authorization Updates for Elitek®, Abraxane® & Paclitaxel Protein- Bound Particles, Neulasta® and Udenyca® Effective March 1, 2023
Audience: Participating Hematologists and OncologistsWe would like to provide advance notice regarding prior authorization requirements for the following drugs when billed under the member’s medical benefit. These updates are effective March 1, 2023, and apply to all lines of business. To ensure accurate prescribing and...
Prior Authorization Update for Neulasta® and Udenyca® (pegfilgrastim) Effective March 1, 2023
Audience: Participating RadiologistsWe would like to provide advance notice regarding prior authorization requirements for Neulasta and Udenyca (pegfilgrastim) when billed under the member’s medical benefit. This update is effective March 1, 2023, and applies to all lines of business. To ensure accurate...
Expansion of Child Health Plus Benefits Effective January 1, 2023
Audience: Providers, Hospitals and FacilitiesAs part of the 2022-2023 New York state budget, Child Health Plus (CHP) benefits were expanded to include medical, behavioral health, dental, ambulance services, and medical supplies, to align with benefits received by children with Medicaid coverage effective January 1,...
Cognitive Rehabilitation Medical Policy Update Effective February 15, 2023
Audience: Physical Medicine and Rehabilitation, and Neurology ProvidersUnivera 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...
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