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Preauthorization Updates Effective October 1, 2022, for All Lines of Business Requiring Preauthorization
Audience: All ProvidersWe would like to share preauthorization updates under our Utilization Management (UM) Program. The UM Program gives Excellus BlueCross BlueShield and its health care provider partners the opportunity to monitor medical episodes of care to prevent unnecessary treatment...
UPDATE – Preauthorization Requirements for Select Cardiology Services
Audience: Participating CardiologistsUnivera Healthcare is keeping a close eye on New York state COVID-19 emergency regulations and executive orders, which continue to be extended. We are also sensitive to staffing challenges that many offices and facilities continue to experience as a result of the...
Updated NDC/HCPCS Codes When Billing for Depo-Provera® (Medroxyprogesterone)
Audience: Participating Providers and FacilitiesWe would like to share an update on the coding required when billing for Depo-Provera (medroxyprogesterone) injections. Please submit all claims for these injections as indicated in the chart below with Healthcare Common Procedure Coding System (HCPCS) code J3490 and the...
Independence Day Office Closure and Pay Cycle Update
Audience: Participating Physicians, Practitioners, Facilities and HospitalsUnivera Healthcare will be closed on Monday, July 4 and Tuesday July 5, 2022 in observance of Independence Day. As a result, our pay cycle schedule for all lines of business will change. Your payment amount will not be affected. Payments and remittance information will...
Drug-Eluting Sinus Stents for Post-operative use following Endoscopic Sinus Surgery Medical Policy Update Effective September 15, 2022
Audience: Participating OtolaryngologistsUnivera 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...
Musculoskeletal Medical Policy Updates Effective September 15, 2022
Audience: Participating Pain Medicine Practitioners, Orthopedic Surgeons, and OrthopedistsUnivera 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...
Juneteenth Pay Cycle Information
Audience: Participating Physicians, Practitioners, Facilities and HospitalsUnivera Healthcare will be closed on Monday, June 20, 2022 in observance of Juneteenth. As a result, our pay cycle schedule for all lines of business will change. Your payment amount will not be affected. Payments and remittance information will be transmitted to...
ICD-10-CM Laterality Policy Update
Audience: Participating Professional ProvidersUnivera Healthcare will implement two claim edits associated with laterality diagnosis coding effective September 1, 2022. According to ICD-10-CM Manual guidelines, some diagnosis codes indicate laterality, specifying whether the condition occurs on the left or right, or...
HIV-Experienced Practitioner 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...
Global Shortage of Iodinated Contrast Media – Preauthorization Update
Audience: Participating Physicians and FacilitiesUnivera Healthcare in partnership with eviCore healthcare MSI, an independent company, is closely monitoring the global shortage of iodinated contrast media and is aligned with recent recommendations from the American College of Radiology Committee (ACR) on Drugs and...
Colorectal Screening Claim Submission for Commercial Business Line
Audience: Physicians and facilitiesWe remind you that the Health Plan adheres to the U.S. Preventative Services Task Force (USPSTF) recommendation for colorectal cancer screening, which was updated on May 18, 2021, to include adults aged 45 to 49 years who are of average risk for colon cancer. The...
Name Matching Issue with Electronic Claim Submissions
Audience: Participating Providers and FacilitiesThanks to your feedback, we were made aware of an issue with electronic claim submissions where some claims were being rejected due to discrepancies between the information submitted and the information printed on the member card. On April 1, 2022, the Electronic Data...
Important Pay Cycle Information
Audience: Participating Physicians, Practitioners, Facilities and HospitalsThere will be a change to our pay cycle schedule for all lines of business due to the Memorial Day holiday. These schedule changes will not affect your payment amount. Payments and remittance information will be transmitted to our remittance vendors, InstaMed® and Zelis®...
Somatuline Depot- Preferred Somatostatin Drug Therapy Effective August 1, 2022
Audience: Endocrinologists and OncologistsSomatuline Depot- Preferred Somatostatin Drug Therapy Analog Effective August 1, 2022 We want to make you aware of a recent change regarding treatment with long-acting somatostatin analog drugs that applies to all lines of health care business. Somatuline® Depot is now...
Preauthorization Requirements for Select Cardiology Services Effective August 1, 2022
Audience: Participating CardiologistsUnivera Healthcare is working with eviCore healthcare MSI, LLC d/b/a eviCore healthcare (“eviCore healthcare”), an independent company, to review for medical necessity and appropriateness of care related to echocardiography and diagnostic heart catheterization...
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