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Medicare MS-DRG Payment Add-On for COVID-19 Hospitalizations
Audience: Participating HospitalsUnivera Healthcare has updated the weighting factor of the assigned Medicare severity diagnosis-related group (MS-DRG) by 20 percent for COVID-19-related hospitalization claims processed on or after June 12, 2020, for our Medicare Advantage members. In an effort to...
Hyaluronic Acid Preferred Therapy Update
Audience: Specialty ProvidersWe want to make you aware of an upcoming change regarding treatment with hyaluronic acid therapy. Effective October 1, 2020, Euflexxa, Synvisc, and Synvisc-One will be our preferred hyaluronic acid therapy products for the treatment of pain in osteoarthritis (OA)...
Eyewear Benefit Clarification for MMC and HARP Members
Audience: Participating Vision Care ProvidersWe would like to provide clarification of the eyewear benefit for Medicaid Managed Care (MMC) and Health and Recovery Plan (HARP) members related to standard vs. non-standard/deluxe frames and lenses. This applies to our members with MyHealthSM and MyHealth PlusSM...
Hemlibra Requires Prior Authorization Effective October 1
Audience: Providers of Impacted MembersWe would like you to be aware of an upcoming change related to the management of Hemlibra®. Starting October 1, 2020 , Hemlibra will be covered under the medical benefit and will require prior authorization for all Commercial, Medicare and Safety Net (Medicaid,...
Metformin ER Recall
Audience: Providers of impacted membersAmneal Pharmaceuticals LLC and Apotex Corp. are voluntarily recalling all lots of Metformin Hydrochloride Extended Release Tablets, USP, 500 mg and 750 mg, within expiry to the Consumer Level. The recall is due to the potential N-Nitrosodimethylamine (NDMA) levels...
July Behavioral Health Training Invitation
Audience: Behavioral Health and Primary Care ProvidersUnivera Healthcare will host the following education and training sessions in July. All providers are welcome. Access registration information from the Staff Training area. Please direct questions to Nafisah.Clay@UniveraHealthcare.com . ...
COVID-19 Reimbursement of Preventive Health Visits via Telehealth Extended to September 7
Audience: Participating PhysiciansIn our communication dated May 13, 2020, we shared the Health Plan’s commitment to ensure continuity of care for our members during the COVID-19 state of emergency, and our efforts to eliminate barriers to providing care during this unprecedented time. We...
Musculoskeletal Preauthorization Procedure for Essential Plan Members Effective August 1
Audience: Physicians, HospitalsWe advise you that effective August 1, 2020, preauthorization requests for musculoskeletal procedures pertaining to Essential Plan members must be submitted directly to the Health Plan. Musculoskeletal-related requests for Commercial and Medicare Advantage business...
Requesting Additional Visits in CareAdvance Provider® Tool
Audience: Physical, Occupational and Speech TherapistsPlease remember when requesting additional visits for an existing authorization in CareAdvance Provider, you must complete the following steps: Locate and open the authorization entry. Be sure you have the correct provider in focus in the top right corner using...
COVID-19 Diagnostic & Antibody Testing Administrative Policy & Information for all Lines of Business
Audience: Physicians, Hospitals, Facilities and LaboratoriesIn our communication to you dated May 21, 2020, we shared Health Plan coverage guidelines and member cost-share information related to COVID-19 diagnostic/viral and antibody testing for our commercial members. The information and guidance we shared in our May 21, 2020...
Electronic Submission Tools
Audience: All providersTo make it easier and more efficient to conduct business with our Health Plan, we are enabling more real-time automation to reduce your administrative burden. As part of our continuing effort to improve our service, we are offering the following electronic submission...
COVID-19 In-Network Outpatient Behavioral Health Services for Essential Workers
Audience: Behavioral Health Providers and FacilitiesOn May 2, 2020, the New York State Department of Financial Services issued an emergency regulation and circular letter that waives member cost-share for outpatient mental health services provided to essential workers during the COVID-19 state of emergency. Under this...
COVID-19 Diagnostic and Antibody Testing Information
Audience: Participating Physicians, Hospitals, Facilities and LaboratoriesFor its commercial members, the Health Plan provides coverage with no member cost-share for COVID-19 diagnostic/viral testing as well as antibody testing that is determined to be medically appropriate for the diagnosis and treatment of an individual by an attending...
Entering Rental Requests in CareAdvance Provider® Tool
Audience: Durable Medical Equipment ProvidersWe remind you that when requesting authorization for a durable medical equipment (DME) rental in CareAdvance Provider, you must include Modifier RR with the HCPCS code. Important note: If the DME item is listed on the National DME Purchase Grid as a rental, the...
COVID-19Telehealth Billing Information for NYS OMH Licensed & Designated Facilities
Audience: NYS OMH Licensed & Designated FacilitiesThe following information is meant to assist you in providing care and easier access to our members during the COVID-19 State of Emergency. We hope that this information helps to address telehealth questions unique to your facility. Telehealth visits are covered for...
