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Essential Plan Administrative Changes
Audience: All ProvidersUnivera Healthcare advises you of an important upcoming administrative change that pertains to our Essential Plan product. Effective February 3, 2020 Please use the following contact numbers for services provided to our Essential Plan members: *Includes...
Important Details Regarding CareAdvance Provider® Tool Launching February 3
Audience: All ProvidersOur new electronic preauthorization system — CareAdvance Provider, is scheduled to be ready for use February 3, 2020, for requesting preauthorizations for the Safety Net line of business. This includes: Medicaid Managed Care (Medicaid Managed Care (Univera...
Ranitidine by Glenmark Pharmaceuticals, Inc. Recall
Audience: Providers of Impacted PatientsGlenmark Pharmaceutical Inc. announced the voluntary recall of all unexpired lots of ranitidine tablets, 150 mg and 300 mg, to the consumer level. The recalled lots of ranitidine tablets 150 mg and 300 mg are being recalled because of the presence or potential presence...
Utilization Management Preauthorization List Updates
Audience: Participating Providers and FacilitiesDuring a recent audit of our medical preauthorization list, we found that a number of codes were inadvertently omitted from the list included on our website, titled “Utilization Management Standard Clinical Review Preauthorization List.” We have and continue to...
Retro Review Process Update for Essential Plan
Audience: Retro Review FacilitiesOur pending transition to CareAdvance Provider, the electronic preauthorization tool that will replace ClearCoverage TM , will result in changes that apply to preauthorizations related to our Essential Plan members. Effective March 30, 2020 , all inpatient and...
Mental Health & Substance Use Disorder Provisions of the Final 2019-2020 NYS Budget
Audience: Participating Behavioral Health and Substance Use Support AgenciesA number of changes regarding coverage of mental health (“MH”) and substance use disorder (“SUD”) benefits were made in the final New York state budget and they become effective for dates of service on or after January 1, 2020. Some changes are required to comply with...
Remittance Reason Code H69 Reminder
Audience: Participating Physicians and FacilitiesWe would like to remind you of remittance reason code H69 that will appear on remittances you receive from us when we process adjustments resulting from third party vendor recoveries. It is important to note that this code is for our internal purposes only and will not...
Radiology Management Program – Important Reminders Regarding “Deemed Status”
Audience: Participating Providers and Health Care ProfessionalsWe would like to provide some reminders about Univera Healthcare’s deemed status program. Additional information related to this program will be provided in a subsequent communication. What is “deemed” or “fast track” status? What is the impact of...
Children's Behavioral Health Services Transitioning to NYS Plan Children & Family Treatment Support and Services
Audience: Participating Behavioral Health Providers and FacilitiesBeginning January 1, 2020 , Medicaid managed care (i.e., MyHealth SM ) will cover more Children and Family Treatment and Support Services (CFTSS). These services help children and their families improve their health, well-being, and quality of life. Effective January...
Reminder: Medicare Advantage Changes Effective January 1, 2020
Audience: All ProvidersWe remind of several changes to our Medicare Advantage line of business effective January 1, 2020. Among the changes for all Medicare Advantage members: New Member Cards are being mailed in December for use beginning January 1, 2020. The new Member Cards will...
Developmental Screening for Autism
Audience: Participating Pediatricians and Family Practice PhysiciansTo promote and improve the early identification of autism before a child’s third birthday, the American Academy of Pediatrics (AAP) has recently published practice guidelines that recommend screening for autism spectrum disorder (ASD) with a standard developmental...
Reminder: Administrative Policy "Related Services" Effective January 1
Audience: All ProvidersUnivera Healthcare will implement a new administrative policy entitled “Related Services,” effective January 1, 2020, for all lines of business. The Health Plan will not cover services deemed to be related to a noncovered surgical service, based on the criteria outlined...
Christmas and New Year's Day Pay Cycle Updates
Audience: Participating Physicians and FacilitiesWe would like to make you aware of office closures and changes to our pay cycle schedule due to the upcoming holiday season. Our offices will be closed on December 24 and December 25, 2019, and January 1, 2020 . It’s important to note that the holidays will...
Medical Utilization Management Program Updates Effective January 17, 2020
We would like to share an overview with you regarding our standard medical Utilization Management (UM) Program updates effective for requests beginning January 17, 2020 . These updates will be posted to Provider.UniveraHealthcare.com on December 15, 2019 . For...
Clinical Updates for Select Diabetic Prescription Medications
Audience: Participating PhysiciansWe would like you to be aware of an upcoming policy update involving select diabetic prescription medications listed in the table below. Starting January 1, 2020 , step therapy requirements for these medications will apply to new and existing users under our...
