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New Electronic Preauthorization Tool Update
You were notified in September of our intention to provide you with a new electronic preauthorization system – CareAdvance Provider®, which will replace our current tool, Clear Coverage TM . We would now like to provide an update regarding the implementation time frame...
Read ArticleVatica Incentive Program Expanding
Dear Participating Physician or Physician Group, Univera Healthcare is pleased to announce that the Well365Plus Solution through an independent company called Vatica Health, Inc. (“Vatica Health”) will be expanded to include Affordable Care Act preventive visits for...
Read ArticleHospice Benefit Clarification
Once a member begins receiving hospice services, all care for their terminal illness will be coordinated by the hospice organization. A review of our records indicates that hospice services for our members who have commercial or Medicaid Managed Care coverage may...
Read ArticleMMC Ovulation Enhancing Drugs Prior Authorization Effective December 1
Medicaid Managed Care plan benefits now cover some ovulation-enhancing drugs for individuals ages 21 through 44 experiencing infertility. The following ovulation enhancing drugs will be covered and will be limited to three cycles of treatment per lifetime: ...
Read ArticleInterQual® Criteria 2019 Update
Our Health Plan uses nationally recognized criteria, including InterQual, to determine appropriateness of care for our members. We would like you to be aware that effective October 15, 2019, we will adopt the 2019 clinical revisions to InterQual criteria, which...
Read ArticleQualified Medicare Beneficiary Billing Update
Univera Healthcare reminds you that under federal law, any member cost sharing resulting from services provided to a Qualified Medicare Beneficiary (QMB) must be billed to Medicaid. QMB members, who are those eligible for both Medicare and Medicaid, cannot be billed for...
Read ArticleCustomer Care Department Closed for Training on October 14
On October 14, 2019, our Customer Care provider phone lines will be closed to allow for staff training and development. Our Medical Intake Customer Care line will remain open with minimal staff available for urgent preauthorization requests. You may reach Medical...
Read ArticleNotification Reminder for Children’s Home and Community Based Services Carved into Medicaid Managed Care
Univera Healthcare (“Health Plan”) is requesting notification upon the initiation of Children’s Home and Community-Based Services (HCBS), in accordance with the New York State’s Children’s Waiver HCBS Plan of Care Workflow. For details, please refer to the New York...
Read ArticleChiropractic Network Management and Administrative Services Transition Effective January 1, 2020
Univera Healthcare is pleased to let you know that effective January 1, 2020, all chiropractic management and administrative services for our members will be handled by our Health Plan directly. Our business relationship with MEDSOLUTIONS, dba eviCore healthcare...
Read ArticleDiabetic Retinopathy Documentation Reminder
Dear Eye Care Specialist: Univera Healthcare is collaborating with primary care providers (PCPs) across our service area to promote diabetic eye exams as a means for addressing the nation’s dramatic increase in diabetic retinopathy in recent years. We need your help. ...
Read ArticleMedicare Advantage Dental Supplemental Benefits
Starting January 1, 2020, we will be offering Dental Optional Supplemental Benefits to our direct pay Medicare Advantage members. Please call Customer Care to verify the member’s eligibility. What’s New: There are no waiting periods for covered services. ...
Read ArticleMedical Utilization Management Program Updates Effective January 1, 2020
We would like to share a general overview regarding our upcoming standard medical Utilization Management (UM) Program updates. The updates are effective for requests beginning January 1, 2020; however, we want to provide you with ample notification to enable you to...
Read ArticleClinical Editing Policy Update – Multiple Endoscopy
Our bulletin issued May 31, 2019 advised you that we would implement the Centers for Medicare and Medicaid Services multiple endoscopy policy effective for dates of service on or after September 2, 2019 for all lines of business. Implementation of this policy has been...
Read ArticleCorrect Billing Codes for Makena
We have recently received quite a few questions about Makena (Hydroxyprogesterone Caproate [HPC]) and correct billing procedures, and we are here to help! Please review the information below for some helpful billing guidelines for Hydroxyprogesterone Caproate (HPC). ...
Read ArticleReminder — Limited Medicaid Coverage of Infertility Drugs Effective October 1
We remind you that effective October 1, 2019, members enrolled in Medicaid Managed Care (MMC) (Univera MyHealthTM) or the Health and Recovery Plan (Univera MyHealth PlusTM) will have coverage that includes medically necessary ovulation enhancing drugs and medical...
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