View Remittance Advice, Claims & Billing UniCare Health Plan of West Virginia, Inc. Medicaid Managed Care Prior Authorization Request Form www.unicare.com UniCare Health Plan of West Virginia, Inc. UWVPEC-1204-19 September 2019 UniCare Health Plan of West Virginia, Inc. (UniCare) precertification phone number: 1-866-655-7423 Fax: 1-855-402-6983 Kaiser Permanente (800) 464-4000. www.kaiserpermanente.org. Please call your provider to understand his/her current telehealth capabilities. West Virginia has adopted one or more of the targeted enrollment strategies outlined in guidance CMS issued on May 17, 2013 . If you're experiencing a mental health crisis, call our Behavioral Health Crisis Line at 1-833-434-1261 (TTY 711) for help. Effective Dec. 5, 2022, we will no longer accept Provider Portal Administrator requests in the current portal. Those provisions will be considered first in determining eligibility for coverage before the medical policy is used to determine medical necessity. 3. UniCare Health Plan of West Virginia, Inc., an Anthem Company. Additionally, some benefit plans administered by the Plan such as some self-funded employer plans or governmental plans, may not utilize the Plans medical policy. Your Essentials account gets you access to all this and more . Med-Pay will be fully compliant with the upcoming ICD-10 mandate by the deadline of October 1, 2014. HealthLink: Grievance & Appeals: 1831 Chestnut Street St. Louis, MO 63103: P.O. Both of these programs include value-based compensation, but also provide support for making changes to the delivery system that drives better care. The PEAR portal offers participating providers a single point of entry to multiple digital tools, including PEAR Practice Management, PEAR Comprehensive Visit, and PEAR Analytics & Reporting. Search for many different types of providers, like: UniCare works with SKYGEN USA Dental for your dental needs. The portal is secure, confidential and easy to use. To access the UniCare provider portal, you need to register and have an account with them. Send Us a Fax or Email Claims Attachments: 612-884-2261 If you log in through a health plan provider website, proceed to that site and follow the instructions there. CMS recently published information regarding payment changes for these drugs in accordance with the ruling from the United States District Court for the District of Columbia. Although paper claims are accepted, physicians, other health care professionals, and facilities are . 9am - 3pm. Quality Care That's Right for YouWhether you need a routine check-up or a specialty procedure, you want the best care you can find.BCBS recognizes doctors and hospitals for their expertise and exceptional quality in delivering care. Mailing Address: Beacon Health Options. Log in to Availity Need an account? Andover, MA 01810. This Physician & Provider Manual is not intended to be a complete explanation of all . You can also find cost share information for inpatient and outpatient behavioral health and substance use services. Policy and Procedure Manual for Beacon Providers . Learn how to update your other insurance information on UMR.com. Clinical UM guidelines are available for adoption to review the medical necessity of services related to the guideline when the Plan performs a utilization review for the subject. Medicare: Medicare Authorization Flexibilities Effective: January 11, 2022. UniCarelicenses and utilizes MCG Care Guidelinesto guide utilization management decisions for some health plans. CarelonRx is an independent company providing pharmacy benefit management services. Complete the online Provider Claim Reconsideration Form, Send a secure message to the Provider Assistance Center. Providers who click the Account Sign In button below are agreeing to the Provider Terms and Conditions. We use cookies to operate our site, help keep you safe, improve your experience, perform analytics, and serve relevant ads. Andover, MA 01810. You can access a provider portal 24 hours a day, seven days a week to manage and improve the health and well-being of more than a million patients. General Self Service (GSS), allows provider offices to use the Internet to verify eligibility and check claims information. In July 2022, CMS and UCare coordinated a recovery process to resend crossover claims missing from the early part of 2022. See the September 1 Provider Bulletin for details. Provider changes UniCare requires all providers, including hospitals, to send any administrative change requests to us so that we have correct information in our system. Please see the December 8 Provider Bulletin for additional details. Provider resources (forms and documents). We maintain a robust provider network that includes more than 4,900 providers and most of the local hospitals and long-term care facilities in Ventura County. UniCare Network Services supports the provider network through the contracting, credentialing and recontracting process and provides ongoing education and support to providers and their office staffs. All Rights Reserved. 2. Follow all prompts to create your new user . Initial Credentialing. Provider Portal Quick Reference Guide (PDF) Need help registering? Were here to work with you to improve the health care of UniCare GIC members. See the January 23 Provider Bulletin for details. and modify user accounts, Claims Attachments: 612-884-2261 Unicare Community Health Center! Download HCAS Provider Enrollment Form Standardized Provider Information Change Form Current Provider Portal Quick Reference Guide (PDF) The clinical utilization management guidelines published on this website are not always used by all plans or lines of business. Uprise Health has been providing EAP and Behavioral Health services for over 33 years through our network of highly qualified, credentialed providers. Lookup authorizations and claim status information. Rate Updates (CAH, RHC, FQHC): RateLetters@UCare.org. Due to larger than normal volumes, the request for Provider Portal Admin access may take longer than five days. Additional medical policies may be developed from time to time and some may be withdrawn from use. Providers Login Due to the current shortage of CT contrast, eviCore medical reviewers are following guidance regarding the appropriate alternative imaging studies, according to our evidence-based clinical guidelines for individual case scenarios. You can access preventive care and prescription savings, as well as exercise programs that fit your lifestyle. National Coverage, Local Expertise. Login to the portal to schedule today! Chat with UniCare in the Availity Portal Get answers to your questions about eligibility, benefits, authorizations, claims status, and more: 1. The UCare Provider Portal allows you to: Access explanation of payments View claim status Complete the online Provider Claim Reconsideration Form Look up member eligibility Check authorization status Send a secure message to the Provider Assistance Center Need help? Siteminder. Members should contact their local customer service representative for specific coverage information. Important information for Medicare Supplement insurance customers: doctors or other providers that accept Medicare Assignment will accept the Medicare-approved amount as payment in full on all Medicare claims, and only bill for any deductible, copay or . You can also call UMR at (888) 440-7342 to update this information. Beginning April 1, 2023, for all products, UCare will deny referred laboratory claims with dates of service Jan. 1, 2019, or later when a claim is received by both a reference laboratory and a referring laboratory for the same member, date of service and procedure code. Easy-to-use tools and resources for your practice. Sign Up to receive provider news from UCare via email. compliance@ucare.org, Access Your Provider Portal Account to access member eligibility The MultiPlan Network is a complementary network for members who choose . Starting April 1, 2023, UCare is updating prior authorization criteria for three drugs that are on the UCare Individual & Family Plans and UCare Individual & Family Plans with M Health Fairview formulary. You can get more information about the providers in our health plan. Register now Our Plans We offer three plans for GIC members who are not eligible for Medicare, all of which offer freedom of choice to see any doctor without a referral, and one plan for GIC members who are eligible for Medicare. Whether its 3 a.m. or a Sunday afternoon with the family, health issues happen at the most inconvenient times and places. Provider Changes UniCare requires all providers, including hospitals, to send any administrative change requests to us so that we have correct information in our system. Additional Information. To determine which clinical utilization management guidelines have been adopted by your plan, or to determine if there are other applicable criteria, please reference the listings provided below. The Portals will not work well, or not work at all, with other browsers. For over 30 years, we have provided health benefits exclusively to state and municipal employees, retirees, and their families insured through the GIC. See the February 17 Provider Bulletin for details. Complete the pre-chat form to start your chat experience. Andover, MA 01810-0916 . If you need assistance, please Click Here or contact the ProviderPortal SM Support Team at (800) 252-2021. . Register now Our Plans We offer three plans for GIC members who are not eligible for Medicare, all of which offer freedom of choice to see any doctor without a referral, and one plan for GIC members who are eligible for Medicare. This document provides a summary of customizations to the MCG Care Guidelines 27th Edition (Publish date March1, 2023). Publish Date the date a medical policy or clinical UM guideline was made available on our public websites Vision services include: To learn more about your vision benefits, call VSP at 1-844-526-0198 (TTY 1-800-428-4833). Fax: (866) 698-6032. Medicaid members can get no-cost rides to your medical appointment. 25 Jun. Registration The register link above is to be completed by only one administrator within your clinic/facility. On July 25, 2022, the U.S. Food and Drug Administration announced Vi-Jon, LLC has voluntarily recalled all lots of Magnesium Citrate Saline Laxative Oral Solution, 10 fl. Check Status. Claims Adjustments: 612-884-2186 Our team consists of highly educated and skilled physicians and mid-level providers. Tufts Health Plan offers a wide range of electronic solutions, including member eligibility status, benefit information, claim submission, claims adjustment functionality and clinical information. Provider Login. <link rel="stylesheet" href="styles.151578c97375b99f6cbe.css"> GSS offers cooperating providers secure on-line access to: Beneficiary eligibility and coverage information. UniCare is a separately incorporated and capitalized subsidiary of WellPoint and serves 30 million members in its . UCare is a registered service mark of UCare Minnesota | 2023 UCare Minnesota. Medicare Eligible At UniCare, we offer Medicare Part D plans which can help you control costs as prescription drug costs continue to rise. Customizations to MCG Care Guidelines 27th Edition. If you log in through AIM, visit the account access page on the ProviderPortal to reset your password. Effective 7/1/2018, submit claims directly to UniCare State Indemnity Plan. UMR is a third-party administrator (TPA), hired by your employer, to help ensure that your claims are paid correctly so that your health care costs can be kept to a minimum and you can focus on well-being. Culture Care Connection From the Payer Spacesapplications tab, select Chat with Payer. The PHCS Health Directions is an extended network which also provides the lowest cost and is intended to provide health care coverage for members traveling outside their service area. 2. West Virginia Children's Health Insurance Plan (WVCHIP): Tobacco cessation benefits Already a member in West Virginia? We are working on updating all documents,but some historic references to Beacon may remain. UniCare is 100% dedicated to providing the best personalized service available. charged for covered services above the amount that UniCare pays to the provider. Copyright 2023 Carelon. www.medicare.gov Important information for Medicare Supplement insurance customers: doctors or other providers that accept Medicare Assignment will accept the Medicare-approved amount as payment in full on all Medicare claims, and only bill for any deductible, copay or coinsurance amount. We work collaboratively with hospitals, group practices, independent behavioral health care providers, community, government agencies, human service districts and other resources. If you are unsure of coverage please contact the National Provider Service Line at 800-397-1630. UCare and CMS remedied this issue beginning April 17, 2022. A clinical UM guideline does not constitute plan authorization, nor is it an explanation of benefits. If you have an urgent request, please outreach to your Provider Relations Consultant. UCare has confirmed these claims were not included by CMS in the recovery process. Under the Consolidated Appropriations Act, 2021 - signed into law on December 27, 2020 - the surprise medical billing provision limits what health plan participants will pay for certain services. Providers Must use ICD-10 Diagnosis Codes Beginning Oct. 1, 2015. Benefit plans vary in coverage and some plans may not provide coverage for certain services discussed in the medical policies. Although paper claims are accepted, physicians, other health care professionals, and facilities are strongly encouraged to submit claims electronically. Login to p rovider web portal at www.directprovider.com The Health Plan Call The Health Plan customer service: 1 -88 8 -613 -8385 Login to the provider web portal at www.healthplan.org UniCare Call Scion's eligibility hotline: 1-888-983-4686 Login to the provider w eb portal at www.sciondental.com Map Location. You will also find benefits information and the status of the yearly deductible. The PEAR portal offers participating providers a single point of entry to multiple digital tools, including PEAR Practice Management, PEAR Comprehensive Visit, and PEAR Analytics & Reporting. Your dashboard may experience future loading problems if not resolved. Choose a topic to learn what Medicare covers and what it doesn't, when to sign up, and how you can get the additional coverage you'll need right here. As eligibility is updated daily, please contact Combined Benefits Administrators to ensure continued coverage at the date of service. And much more! UCare follows the Centers for Medicare and Medicaid Services (CMS) billing requirements and reimbursement guidelines for certain drugs purchased under the 340B Drug Pricing Program. Use the form below to setup your Admin account. Hours: 8 am - 5 pm, Monday through Friday. To see a list of all medical policies and clinical UM guidelines, visit our My Blog unicare provider portal eligibility With access to your secure account, you can: Change your primary care provider (PCP). Provider Orientation Webinars UniCare offers a monthly provider orientation webinar the third Tuesday of each month from 12:00 p.m.--1:00 p.m. Topic covered o Who we are o Health Care Management Services o Case Management o Community Outreach o Resources Available o Many more topics.. UniCare Health Plan of West Virginia, Inc. 6 Request a call back from the Customer Care Center. See the February 24 Provider Bulletin for details. Because local practice patterns, claims systems and benefit designs vary, a local plan may choose whether to implement a particular clinical UM guideline. Brickstone Square, 1st Floor. MultiPlan Providers Learn more. This may include but is not limited to decisions involving pre-certification, inpatient review, level of care, discharge planning and retrospective review. Please use the new Provider Portal if you would like to register to be a Provider Portal Administrator. Please use the new Provider Portal if you would like to register to be a Provider Portal Administrator. Enjoy the cost and time-savings of one-stop access to member eligibility, claims, authorization information, and more. Additional details and links to exclusive discounts can be found in the brochure. Please complete a separate page for all new providers in the group. UCare has also confirmed that DME claims cannot be included in a similar recovery process. Closed. Customizations to MCG Care Guidelines 25th Ediition Effective Jan. 1, 2023, UCare members enrolled in Prepaid Medical Assistance Program, MinnesotaCare, UCares Minnesota Senior Health Options, Minnesota Senior Care Plus, UCare Connect and UCare Connect + Medicare are eligible to access substance use disorder (SUD) services after completing a SUD screening through the SBIRT process. Check claim status Medical technology is constantly evolving and clinical UM guidelines are subject to change without notice. UCare requires notification at three junctures in a members transplant journey. Providers should select option 1 for EFT or ERA questions. Join Coventry We appreciate your interest in joining the Coventry Network. The UniCare provider portal gives you the information, tools and resources you need to support the day-to-day needs of your patients and office. The medical policies do not constitute medical advice or medical care. Beacon Health Options serves more than 40 million people across all 50 states. All rights reserved. Behavioral health providers. If you've forgotten your Username, or for additional assistance, please contact Customer Service at 877.927.1112. If you have not registered in the new portal, please do so, or if you are not a Provider Portal Administrator and need to be added, please contact your Portal Administrator with questions on access. See the January 30 Provider Bulletin for details. 2000-2021 UniCare. Official Site of Anthem Blue Cross Blue Shield, a trusted health insurance plan provider. VSP Vision Care | Vision Insurance. If your patient has UniCare dental benefits and an affiliated medical plan, you can: Patient Health Record can positively affect your patients care and your practice. Join Our Network. E-mail: e-supportservices@beaconhealthoptions.com. The doctors, hospitals, and other providers which are part of the network of providers referred to in this document are independent contractors who exercise independent judgment and over whom we have no control or right of control. Join Our Network. If so, now is the time to make sure your tax IDs and other important information are registered on the new web portal. If you would like to request a hard copy of an individual clinical UM guideline or MCG guideline, please contact the member's health plan at the number on the back of their identification card. Benefit plans vary in coverage and some plans may not provide coverage for certain services discussed in the clinical UM guidelines. Send our Provider Service team secure messages. Only one Administrator per facility may register for the Portal. Attn: Grievance & Appeals Department. Note that while a publish date is enterprise-wide, the implementation date may differ depending on notification requirements. Because practice patterns, claims systems and benefit designs vary, a local plan may choose whether to adopt a particular clinical UM guideline. Call CHC Support Team for service: 1-866-506-2830. UCare Provider Portal Charleston, WV 25321-0091. Welcome ProviderPortal ProviderPortal A fast, easy way to access AIM Specialty Health In a busy practice like yours, you need to deliver quality, appropriate care efficiently to your patients. The portal is free of charge for all participating providers. Phone: (978) 470-1795. All Kids and FamilyCare Programs. Authorizations must be submitted to Beacon. Note that where we have developed a medical policy that addresses a service also described in one of these other sets of criteria, UniCares medical policy supersedes. Take me to the Provider Search directory. Don't have an account yet? Clinical UM guidelines can be highly technical and complex and are provided here for informational purposes. Provider Portal Registration. You can also send us an appeal by filling out a Member Appeal Request Form and sending it to us. If you're a first-time user, setting up an account is easy. This page provides links to information Medicaid Providers may need in order to better serve their patients and/or to better understand the Medicaid Program. Find A Form In the coming weeks, Portal Administrators and Users will be notified to set up their accounts in the new portal. If you have any questions, or need assistance locating a provider, please call UniCare Member Service toll free (833-663-4176 for Basic, PLUS and Community Choice member or 800-442-9300 for Medicare Extension members). Log in to your account and send us a message. The medical policies generally apply to all of the Plans fully-insured benefits plans, although some local variations may exist. Prescription Drug Benefits - CVS SilverScript. As a reminder, UCare denies claims for providers administering Part D vaccines in their clinics. Provider (For all members) Preferred Vendors Get a list of contracted providers for the services listed below to be sure you are referring your patients to a contracted provider so they get 100% coverage for these services (versus 80% coverage with other vendors). Submit paper claims to the below address: UniCare State Indemnity Plan . Log in to your account and send us a message. If you have questions about your benefits, visit Express-Scripts.com or call ESI Express Scripts Pharmacy at 855-230-7778. New codes have been identified for 2023 and will be accepted into the UCare system. Today we are Carelon Behavioral Health. Learn more. This may include but is not limited to decisions involving prior authorization, inpatient review, level of care, discharge planning and retrospective review. Notification of Provider Changes Any provider or location that is not listed in the directory is not contracted with Beacon at this time. This is page 1 of 2 for creating your account. Chat with UniCare in the Availity Portal Get answers to your questions about eligibility, benefits, authorizations, claims status, and more: 1. New codes will have published effective dates but are subject to the editing update and implementation dates. New Claims System If the Tax ID for your facility or practice has already created an account to utilize the CareSource Provider Portal, a new account cannot be created. We ensure all clients have rapid access to superior care for their employees, members and dependents when and where they need it. If an Admin has already registered for your facility please contact them to . Visit https://provider.unicare.com > Resources > Learn About Availity to find the most recent version of this document. UniCare licenses and utilizes MCG Care Guidelines to guide utilization management decisions for some health plans. This is page 1 of 2 for creating your account.