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Medicare Advantage Changes Effective January 1, 2022
Audience: All providersMedicare Advantage members will soon receive their Annual Notice of Changes (ANOC) with details about the following benefit and administrative changes effective January 1, 2022. The Annual Enrollment Period (AEP) extends from October 15 to December 7, 2021. Medicare...
Philips Respironics Respiratory Recall
Audience: Durable Medical Equipment ProvidersAs you may be aware, Philips Respironics issued a recall on June 14, 2021 for specific continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP) devices, and mechanical ventilators. Suppliers of impacted devices should work with their...
CareAdvance Provider® Authorization Tool Enhancements
Audience: All ProvidersUnivera Healthcare would like you to be aware that our CareAdvance Provider authorization tool will be upgraded effective September 13, 2021. We are excited to share with you that the upgrade includes several enhancements that will help you streamline your process for...
Mandatory Use of Web for Determining Services Requiring Preauthorization
Audience: All ProvidersOur website contains a wealth of information designed to help you conduct your business with the Health Plan quickly and efficiently and to avoid lengthy waits to reach our Customer Care representatives. Effective December 1, 2021, you will be required to use our...
Labor Day Pay Cycle Information
Audience: Participating Physicians, Practitioners, Facilities and HospitalsUnivera Healthcare will be closed on Monday, September 6, 2021, in observance of Labor Day. There will be a change to our pay cycle schedule for all lines of business due to this holiday. These schedule changes will not affect your payment amount. Payments and remittance...
Federal Requirements Effective January 1, 2022
Audience: All ProvidersWe would like to share changes to key Univera Healthcare tools for members and other consumers effective January 1, 2022, required under the Consolidated Appropriations Act, which was signed into federal law on December 27, 2020. Final regulations, which have yet to be...
Use our Web Self-Service Tools for Faster Service
Audience: Participating Physicians, Health Care Practitioners & FacilitiesIf you have recently experienced longer than normal wait times when contacting Customer Care, we thank you for your patience. We anticipate significant improvements in wait times after Labor Day. We would like to remind you of the time-saving tools and information...
Administrative Policy 09 – Therapeutic Injections; Trigger Point, Tarsal Tunnel, Ligament Cyst, Tendon Sheath and Facet Joint – Update effective November 1, 2021
Audience: All ProvidersUnivera Healthcare is updating the following administrative policy effective November 1, 2021, to define the coverage and billing guidelines for therapeutic injections; trigger point, tarsal tunnel, ligament cyst, tendon sheath and facet joint billed by providers...
Retention of Sterilization and Hysterectomy Consent Forms for Medicaid Managed Care Members
Audience: Participating ProvidersWhen submitting a claim for a sterilization or hysterectomy procedure performed on a Medicaid Managed Care (MMC) or Health and Recovery Plan (HARP) member, the performing provider must retain a copy of the completed Sterilization Consent Form (LDSS-3134) or...
Preauthorization Updates Effective November 1, 2021 for All Lines of Business Requiring Preauthorization
Audience: All Participating ProvidersWe would like to share updates to 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 and duplication of services. The...
Update to Preferred Therapy for Pulmonary Arterial Hypertension Drugs Effective September 1, 2021
Audience: Cardiologists and PulmonologistsWe want to make you aware of an upcoming medical benefit change regarding treatment for pulmonary arterial hypertension (PAH). Effective September 1, 2021, the generic versions of Remodulin®, Flolan®, and Veletri® will be our preferred products for the treatment of...
Velcade® is the Preferred Therapy over Kyprolis® for certain indications
Audience: Oncologists and HematologistsWe want to make you aware of an upcoming change to the prior authorization criteria for Kyprolis®. This policy change was reviewed and approved by our Pharmacy & Therapeutics Committee, which includes local physicians and pharmacists who are not employed by our Health...
Register to Receive our Newsletter and Other Communications Electronically
Audience: Participating Physicians, Health Care Practitioners & Facilities**If you already receive email notification each month when the latest issue of our Examiner newsletter is available online, you can disregard this notice.** We encourage you to take a moment to visit our website and register to receive electronic communications from...
Discontinuation of Utilization Management (UM) Fax Lines
Audience: Participating Physicians, Professional Health Care Practitioners & FacilitiesWe are working diligently to improve our service to you by implementing the most up-to-date technology available. As part of our effort, we will provide you with real-time, streamlined tools for submitting medical records related to preauthorization requests beginning on...
Breast Pump Administrative Policy Effective November 1, 2021
Audience: Durable Medical Equipment providersUnivera Healthcare is implementing the following administrative policy November 1, 2021, to define the coverage and billing guidelines for breast pumps billed by providers contracted to provide this service. You can access the individual policies by clicking here. Note:...
