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Medicare Advantage Prior Authorization for Select Oncology Medications
Audience: Prescribing ProvidersIn an effort to reduce costs while maintaining high safety, efficacy, and quality standards, we are implementing new prior authorization (PA) requirements on select medical benefit oncology medications for members enrolled in Medicare Advantage plans. For members...
Streamlined Preauthorization for Medical Specialty Drugs for Commercial Fully Insured Members Effective January 1, 2023
Audience: Prescribing ProvidersBased on feedback received from prescribing providers related to notification review/preauthorization requirements for medical specialty drugs, Univera Healthcare will update its requirements for commercial fully insured members effective January 1, 2023. To...
Updated Participating Provider Manual Now Available
Audience: Participating Physicians, Health Care Practitioners and FacilitiesThe Univera Healthcare Participating Provider Manual has been updated and is now available on our website, UniveraHealthcare.com/policies/manuals. You will need to log in to the secure portion of the website to view the manual. Once logged in, you now have the option to...
Medicare Advantage Changes Effective January 1, 2023
Audience: All providersMedicare Advantage members will receive their Annual Notice of Changes soon with details about the following benefit and administrative changes effective January 1, 2023. The Annual Enrollment Period extends from October 15 to December 7, 2022. Medicare beneficiaries...
Reminder: Pharmacy Billing Guidance for Non-Enrolled Unlicensed Prescribers
Audience: PharmaciesThe New York State (NYS) Medicaid program requires enrollment of all licensed providers who serve Medicaid members, including prescribing practitioners identified on pharmacy claims, per the Centers for Medicare & Medicaid Services (CMS) and federal...
NDC Billing Requirement Update Effective December 1, 2022
Audience: Participating Prescribing ProvidersTo ensure that your claims are submitted accurately, and to allow for timely processing and correct reimbursement, please review the claim billing requirements effective December 1, 2022, for the following drugs: HCPCS Code Description ...
Register to Receive our Newsletter and Other Communications Electronically
Audience: Participating Physicians, Health Care Practitioners and 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...
Clinical Editing Policies Effective December 1, 2022
Audience: All Providers and FacilitiesWe would like you to be aware of new clinical edits effective for dates of service on or after December 1, 2022. These edits do not impact the retrospective review of claims that currently occur, and apply to physicians, practitioners, laboratories, outpatient facilities...
Resumption of Utilization Review Requirements Suspended Under NYS Executive Order #4
Audience: Participating HospitalsNote: If your NYS-approved certification to suspend preauthorization requirements has already ended at your request, please disregard this message. The New York State Department of Health (NYS DOH) has announced that it will not continue the suspension of utilization...
Holiday Office Closures and Pay Cycle Schedule Changes for Remainder of 2022
Audience: Participating Physicians, Practitioners, Facilities and HospitalsTo help you plan ahead, we are providing you with advance notice of Univera Healthcare office closure information for the following holidays. Please refer to this convenient chart as a guide to our upcoming closures and pay cycle schedule changes for all lines of...
Medical Policy Update: Minimally Invasive Treatments Prostatic Hyperplasia
Audience: Participating UrologistsUnivera 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...
Training Opportunity: eviCore Cardiology Preauthorization Tool
Audience: Participating CardiologistsIn preparation for the October 1 implementation of preauthorization requirements for outpatient transthoracic and transesophageal echocardiography services, we are pleased to share information about upcoming virtual training sessions available to assist you. Univera...
Faxing Medical Records – New Page Limit
Audience: All ProvidersOur goal is to help reduce your administrative burden and costs as you conduct business with the Health Plan. As part of this effort, we would like to suggest solutions for reducing the amount of paper your office generates when transferring important medical record...
Zarxio® is the Preferred Filgrastim Therapy for Medicare Advantage Effective November 1, 2022
Audience: Prescribing ProvidersWe want to make you aware of an upcoming change regarding treatment with colony stimulating factors for Medicare Advantage members that will apply under the medical benefit. The biosimilar Zarxio (filgrastim-sndz) is now our preferred filgrastim therapy for the...
OncoHealth Consultative Partnership
Audience: Hematologists and OncologistsUnivera Healthcare is pleased to let you know that we are partnering with OncoHealth, an independent company, to provide clinical expertise regarding hematology and oncology medical specialty drug and pharmacy drug prior authorization reviews. OncoHealth may reach...
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