News Archive

Showing 76– 90 of 116 Results

Latest News

Medical Utilization Management Program Updates Effective April 6, 2020

Audience: All providers

We would like to share an overview with you regarding our standard medical Utilization Management (UM) Program updates effective for requests beginning April 6, 2020. These updates will be posted on March 27, 2020 For services already existing on our preauthorization...

COVID-19 Testing Codes; No Member Cost-Share for Telehealth Visits

Audience: Participating Providers and Facilities

We are providing an update on the information we currently know related to Novel Coronavirus (COVID-19) to assist you in your day-to-day business with us. Please check our COVID-19 page and the News & Updates section regularly, as developments are evolving rapidly....

Advanced Opioid Management Program Updates

Audience: Participating Providers

The Advanced Opioid Management Program has successfully reduced the risk of opioid abuse and misuse in the community since implementation on July 1, 2018. This program, in combination with provider vigilance of opioid prescribing has: Reduced the average day supply per...

Coronavirus (COVID-19) Update

Audience: Providers and Facilities

Univera Healthcare is closely monitoring Novel Coronavirus (COVID-19). Our top priority is the health and well-being of the members that we serve. Because the COVID-19 situation is rapidly evolving, the U.S. Centers for Disease Control and Prevention website remains the...

2020 HIPPS Codes Required on Medicare Advantage Home Health Claims Effective May 1

Audience: Certified Home Care Agencies

We advise you that claims received on or after May 1, 2020 with 2020 dates of service, will require valid 2020 Health Insurance Prospective Payment System (HIPPS) codes. Use of 2020 HIPPS codes will not have any impact on reimbursement. Your current reimbursement rate...

Durable Medical Equipment (DME) Online Resources

Audience: DME Providers

Our website contains several resources that we recommend you use prior to issuing durable medical equipment to our members and submitting claims. DME Rental / Purchase Grid A DME rental vs. purchase grid is available to assist you in determining the codes with...

Medical Utilization Management Program Updates Effective June 1, 2020

Audience: Providers and Facilities

NOTE: Preauthorization added to codes for Univera Healthcare MyHealthSM, MyHealth PlusSM, Child Health Plus and the Essential Plan. Additional details are included below.    We would like to share an overview with you regarding our standard medical Utilization...

Requesting Additional Units Using CareAdvance Provider® Tool

Audience: Durable Medical Equipment Providers

We would like to provide clarification regarding the new process for requesting additional units for Durable Medical Equipment through our new CareAdvance Provider online authorization tool. If you have an authorization that was entered originally using our Clear...

CareAdvance® Provider Preauthorization Tool Expansion to Medicare and Commercial Lines of Business

Audience: All Providers

We announced previously that our new electronic preauthorization system, CareAdvance Provider, would be introduced in phases beginning with the Safety Net line of business on February 3, 2020. We would now like to provide you with advance notice regarding the transition...

Correct Coding in CareAdvance Provider® Preauthorization Tool

Audience: Physical Therapy, Occupational Therapy and Home Care providers

We remind you that the same coding rules that applied in the Clear CoverageTM authorization tool also apply when requesting authorization in our new CareAdvance Provider tool. Please help us to process your authorization request correctly and efficiently by applying the...

Requesting Additional Visits for Essential Plan Members

Audience: All Providers

We would like to provide clarification regarding the new process for requesting additional visits for our Essential Plan members due to our transition to the new CareAdvance Provider® authorization tool. If you have an authorization that was entered originally using our...

CareAdvance Provider® Preauthorization Tool Reminder and Tips

Audience: All Providers

We remind you that our new CareAdvance Provider online authorization tool should now be used when requesting preauthorization for our Safety Net members. This includes Medicaid Managed Care (Univera Healthcare MyHealthTM and Univera Healthcare MyHealth PlusTM), Child...

Reminder: Update to NYS Government Programs Coverage of Urinalysis Code G0480

Audience: Providers, Facilities

Univera Healthcare reminds you that effective for dates of service on or after February 20, 2020, billing for HCPCS code G0480 will be limited to once per date of service, and this code may be billed up to a maximum of six (6) times within 365 days. In addition, G0480 may...

Clarification – Medical Utilization Management Program Updates for Safety Net Members Effective January 17

Audience: All providers, facilities, hospitals

Our bulletin issued December 10, 2019, notified you that preauthorization requirements for some services for Safety Net members would be lifted effective January 17, 2020. In addition, be advised that preauthorization is NOT required for the following codes shaded in gray...

Invokana and Invokamet Removed from MMC Formulary

Audience: Providers of Impacted Members

All Sodium-Glucose Co-Transporter 2 (SGLT2) inhibitors are indicated as adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes and offer similar glycemic efficacy.  Available treatment guidelines do not prefer one SGLT2 inhibitor over...

Showing 76– 90 of 116 Results