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Latest News

Bright Beginnings Prenatal Incentive Program

Audience: Physicians and Nurse Midwives

As you may know, we provide an incentive to participating physicians and nurse midwives providing prenatal care to members enrolled in “Safety Net” (Child Health Plus, and Univera Healthcare MyHealthSM and MyHealth PlusSM ) products through our Bright Beginnings program....

Administrative Policy AP-26 – COVID-19 Viral and Antibody Testing; Reimbursement Update Effective January 21, 2021

Audience: Physicians and Facilities

We advise you that Univera Healthcare Policy AP-26 COVID-19 Viral and Antibody Testing will be updated effective January 21, 2021, to define the coverage, reimbursement and billing guidelines for COVID-19 testing. You can access the individual policies by clicking here....

November Behavioral Health Training Schedule

Audience: PCPs and Behavioral Health providers

Univera Healthcare will host the following education and training sessions in November. All providers are welcome.   Access registration information from the Staff Training area. Please direct questions to Nafisah.Clay@UniveraHealthcare.com.   ...

New Payment Process Effective November 20, 2020

Audience: All Participating and Non-Participating Providers

We are pleased to announce that Univera Healthcare has partnered with Zelis® Payments, an independent company and will be offering ePayment options that can accelerate the settlement of claim payments. This service will be available for all lines of business.  Zelis...

Helpful Reminders for the 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 the...

Coding Guideline Changes for Outpatient Hospital Facilities Effective January 1, 2021

Audience: Hospitals

Effective January 1, 2021, Univera Healthcare will require CPT/HCPCS codes to be billed with most revenue codes billed on UB-04 type of bill 013X.  A summarized list of revenue codes that require CPT/HCPCS coding is enclosed.  The full, detailed list may be...

Utilization Review for Inpatient Rehabilitation Services Effective January 1

Audience: Hospitals, skilled nursing facilities

Univera Healthcare would like you to be aware of an upcoming reduction in the allowed time frame health plans will have to make preauthorization determinations and provide written and verbal notice for inpatient rehabilitation services provided by a skilled nursing...

Check eMedNY for MMC and HARP Members

Audience: All providers

Our claims processing system will be continuously updated to reflect CPT® codes that are not covered benefits for Medicaid Managed Care (MMC) and Health and Recovery Plan (HARP) members per the Medicaid eligibility verification system, eMedNY.org. This applies to our...

Extension of Cost-Share Waiver for In-Network Outpatient Behavioral Health Services for Essential Workers to Nov. 27

Audience: Behavioral health providers and facilities

On September 29, 2020, the New York State Department of Financial Services issued an extension of its emergency regulation and circular letter, which waives member cost-share for outpatient mental health services provided to essential workers during the COVID-19 state of...

Diabetic Step Therapy Update for 2021

Audience: Providers of impacted patients

We would like you to be aware of an upcoming policy update involving select diabetic prescription medications listed in the table below. Starting January 1, 2021, step therapy requirements for these medications will apply to new and existing users under our commercial...

Utilization Management Program-Preauthorization Updates Effective November 1, 2020

Audience: All Providers

We would like to share updates with you regarding preauthorization under our Utilization Management (UM) Program and application of National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) for Medicare Advantage.  The UM Program gives Univera...

HEDIS® Specification Updates

Audience: All Physicians

Univera Healthcare would like to make you aware of some important updates to the HEDIS measures that were released on July 1, 2020, from the National Committee for Quality Assurance (NCQA). The updates are for the measurement year 2020 (January 1, 2020 – December 31,...

Thyroid Medication Recall: NatureThroid and WP Thyroid

Audience: Providers of impacted patients

RLC Labs, Inc. is voluntarily recalling Nature-Throid® and WP Thyroid® in all strengths, all counts of product within current expiry to the consumer level. The products are being recalled because testing of samples from six (6) lots by the U.S. Food and Drug...

Member Cost-Share Waiver Update for COVID, non-COVID Telehealth Services

Audience: Professional Providers, Hospitals and Certified Home Healthcare Agencies

Please review the important updates below related to our extension of the member cost-share  waiver and continued provider reimbursement for COVID-19 and non-COVID-19 telehealth services.  We will continue to monitor the federal public health emergency and the...

Updates to Administrative Policy-15 Part III: Evaluation & Management and Vaccine Administration Effective December 17, 2020

Audience: All Physicians

Univera Healthcare is updating Administrative Policy-15 to include a new Part III effective December 17, 2020, to define billing and reimbursement guidelines. You can access the individual policies by clicking here. Note: You must login with your username and password to...

Showing 1– 15 of 117 Results