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Showing 1– 15 of 145 Results

Latest News

Medicare MS-DRG Payment Add-On for COVID-19 Hospitalizations

Audience: Participating Hospitals

Univera 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 Providers

We 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 Providers

We 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 Members

We 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 members

Amneal 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 Providers

Univera 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 .   ...

COVID-19 Reimbursement of Preventive Health Visits via Telehealth Extended to September 7

Audience: Participating Physicians

In 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, Hospitals

We 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 Therapists

Please 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 Laboratories

In 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 providers

To 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 Facilities

On 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 Laboratories

For 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 Providers

We 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 Facilities

The 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...

Showing 1– 15 of 145 Results