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Audience: Participating Physicians, Health Care Practitioners and Facilities

**If you already receive an email notification quarterly 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...

Billing Requirements for Administrative Policy AP-26 – COVID-19 Viral and Antibody Testing; Reimbursement Information

Audience: Physicians, Hospitals, Facilities and Laboratories

Univera Healthcare implemented Administrative Policy AP-26 COVID-19 Viral and Antibody Testing effective March 13, 2020, to define the coverage, reimbursement and billing guidelines for this testing when it is determined to be medically appropriate for the diagnosis and...

August 2020 Behavioral Health Training Schedule

Audience: Primary Care and Behavioral Health Providers

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

CareAdvance Provider® Reminders

Audience: All providers, facilities, hospitals

Thank you for the care that you deliver to our valued members each day. We would like to provide you with some helpful tips and reminders regarding CareAdvance Provider, our new online preauthorization tool for Safety Net, Commercial and Medicare Advantage lines of...

Medical Utilization Management Updates

Audience: All Providers, Facilities, Hospitals

We would like to share an overview with you regarding our standard medical Utilization Management (UM) Program updates coming soon. Breast reconstruction, including implant insertion, removal or reinsertion continues to require pre-authorization unless the member has a...

Reminder: Refund Request Notification Process

Audience: All providers

We are writing to remind you of our automated notification process for requesting a refund on any claim we paid or overpaid in error. When we process a retraction for claims we paid or overpaid in error, a refund request is immediately generated if we are unable to...

De-Implementing Temporary COVID-19 Hospital Contingencies

Audience: Participating Hospitals

On June 26, 2020, the New York State Department of Financial Services (NYS DFS) issued Supplement No. 2 to its Insurance Circular Letter No. 8. The supplement provides guidance that permits health insurers, including Univera Healthcare, to resume preauthorization,...

Medicare MS-DRG Payment Add-On for COVID-19 Hospitalizations

Audience: Participating Hospitals

Univera Healthcare has updated the weighting factor of the assigned Medicare severity diagnosis-related group (MS-DRG) by 20 percent for COVID-19-related hospitalization claims processed on or after June 12, 2020, for our Medicare Advantage members. In an effort to...

Hyaluronic Acid Preferred Therapy Update

Audience: Specialty Providers

We want to make you aware of an upcoming change regarding treatment with hyaluronic acid therapy. Effective October 1, 2020, Euflexxa, Synvisc, and Synvisc-One will be our preferred hyaluronic acid therapy products for the treatment of pain in osteoarthritis (OA) of the...

Eyewear Benefit Clarification for MMC and HARP Members

Audience: Participating Vision Care Providers

We would like to provide clarification of the eyewear benefit for Medicaid Managed Care (MMC) and Health and Recovery Plan (HARP) members related to standard vs. non-standard/deluxe frames and lenses. This applies to our members with MyHealthSM and MyHealth PlusSM...

Hemlibra Requires Prior Authorization Effective October 1

Audience: Providers of Impacted Members

We would like you to be aware of an upcoming change related to the management of Hemlibra®. Starting October 1, 2020, Hemlibra will be covered under the medical benefit and will require prior authorization for all Commercial, Medicare and Safety Net (Medicaid, HARP,...

Metformin ER Recall

Audience: Providers of impacted members

Amneal Pharmaceuticals LLC and Apotex Corp. are voluntarily recalling all lots of Metformin Hydrochloride Extended Release Tablets, USP, 500 mg and 750 mg, within expiry to the Consumer Level. The recall is due to the potential N-Nitrosodimethylamine (NDMA) levels greater...

July Behavioral Health Training Invitation

Audience: Behavioral Health and Primary Care Providers

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

AP-34 Optometry Scope of Practice Administrative Policy Effective October 1, 2020

Audience: Optometrists

Univera Healthcare is implementing the following administrative policy October 1, 2020, to define the coverage and billing guidelines for Optometry Scope of Practice. This policy is in line with Current Procedural Terminology (CPT), and Healthcare Common Procedure Coding...

COVID-19 Reimbursement of Preventive Health Visits via Telehealth Extended to September 7

Audience: Participating Physicians

In our communication dated May 13, 2020, we shared the Health Plan’s commitment to ensure continuity of care for our members during the COVID-19 state of emergency, and our efforts to eliminate barriers to providing care during this unprecedented time.  We...

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