Resources for Providers
Here are links to a variety of helpful resources for providers:
Electronic Claims & Eligibility Resources:
HIPAA Version 5010 Update
File Claims Electronically – Get details on how to send claims to the Plan electronically.
Check Claims & Eligibility Information – You can access this information via the web or interactive voice response (IVR):
- AccessPoint – Access online eligibility and claims information, through UniCare's AccessPoint, for your patients enrolled in the UniCare State Indemnity Plan. Register on our secure, authorized web site to get started.
Important: The benefits information on AccessPoint does not apply to UniCare State Indemnity Plan members, as our plan benefits are customized for individuals insured through the Group Insurance Commission. To access benefits information for UniCare State Indemnity Plan members, click here.
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24-hour IVR Access to Claims and Eligibility Information – Use our interactive voice response (IVR) system to access claims and eligibility information for your patients who are UniCare State Indemnity Plan members. Find out how to access the IVR.
Plan Information:
2010-2011 Benefits – Get benefits information for our four different plan options, including access to our Member Handbooks, Benefit Updates and detailed benefit descriptions of certain member benefits such as cardiac rehabilitation programs and infertility services.
Notification Requirements (Rev. 7/10) – Find out which procedures require pre-notification and how much notice is required.
Updates to McKesson's ClaimsXten™ Rules for 2010 – Get details on the changes that will occur
throughout 2010 to certain claim edits used by UniCare.
WellPoint Medical Policies – UniCare, a subsidiary of WellPoint, specifically excludes coverage for services or supplies it determines to be investigational and/or not medically necessary. The UniCare State Indemnity Plan processes claims in accordance with these determinations, which are indicated in WellPoint's medical policies.
Filing an Inquiry, Complaint or Grievance/Appeal – Get information on the different ways you can initiate an inquiry, complaint or grievance/appeal with the plan.
Provider Listings:
View Physician Tier Listing
Preferred Vendor List – 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 percent
coverage for these services (versus 80 percent coverage with other vendors).
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home health care
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home infusion therapy
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medical supplies
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diabetic supplies
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durable medical equipment
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therapeutic air flow pressure relief mattresses
Additional Information:
Clinical Performance Improvement (CPI) Initiative – Get details on the Plan's CPI program for FY2011.
Hospital Safety Initiatives – Medical errors in hospitals are more prevalent than you may realize. The Institute of Medicine reports that many of these errors are preventable.
In response to this problem, the Leapfrog Group has developed four initiatives to help hospitals reduce preventable medical mistakes. Learn about Leapfrog's initiatives and find out which hospitals use these key safety practices to protect patients. This information will also help you select a hospital for your patients.
Serious Reportable Adverse Health Care Events –
The Plan does not pay for costs associated with 28 serious preventable adverse health care events, in line with
the Commonwealth's commitment to patient safety. Learn more.
Contact Us – E-mail us or get contact information for the Plan, CVS Caremark and United Behavioral Health.
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