UniCare is closely monitoring COVID‑19 developments and what it means for our customers and our health care provider partners. Our clinical team is actively monitoring state and federal regulations and reports from the Centers for Disease Control and Prevention (CDC) to help us determine what action is necessary on our part.
UniCare has made the following changes to plan benefits in order to remove barriers to treatment, and to help prevent the spread of the virus.
These changes apply to all providers and members nationwide.
Information about how to appropriately bill for telehealth and COVID‑19 diagnosis and treatment is available in the COVID-19 Billing Spreadsheet.
For all telehealth services including primary care, specialty care and behavioral health visits, UniCare will reimburse providers up to the same rate as the in-person reimbursement rate. There is no member cost share (copays, coinsurance or deductible) for telehealth visits with any diagnosis code. Both audio/video and telephone-only sessions are covered.
Refer to the COVID-19 Billing Spreadsheet for information on how to bill appropriately for telehealth.
There is no member cost share for the following services when they are performed for the diagnosis and treatment of COVID‑19:
There is no member cost share for the following services for the treatment of confirmed COVID-19:
Refer to the COVID-19 Billing Spreadsheet for applicable diagnostic codes and other information on how to bill appropriately for these services. If these services are billed with diagnosis codes not related to COVID‑19, standard member cost sharing will apply.
Providers should adhere to the following guidelines when billing for telehealth services or services for the diagnosis and treatment of COVID‑19:
Refer to the COVID-19 Billing Spreadsheet for specific diagnosis codes and additional details about appropriate billing for telehealth and COVID‑19 diagnosis and treatment.
UniCare has temporarily modified prior authorization requirements for several services as of March 1, 2020. Check the COVID-19 Preauthorization Spreadsheet to see what has changed related to preauthorization requirements.
For most of the listed services, UniCare is implementing a notification-only requirement.
Consistent with existing policies, the admitting provider must notify UniCare of the admission or service; however, UniCare will not perform reviews for medical necessity. The notification-only requirement enables UniCare to assist members during their care transitions. When no notification is received, UniCare will conduct a retrospective review.
The notification-only requirement applies to the initial request only. Reviews for medical necessity will still be performed upon receipt of continued service requests for these services.
During this same period, UniCare will waive late notification penalties.
Refer to Massachusetts Rehab Hospitals Contracted with UniCare for a list of contracted inpatient rehab facilities in Massachusetts.
All skilled nursing facilities in Massachusetts are reimbursed at the contracted benefit.
UniCare will reimburse providers for the COVID-19 vaccine administration per CMS guidelines and the Commonwealth of Massachusetts Division of Insurance guidelines. Providers should submit a claim and UniCare will reimburse based on the applicable COVID-19 vaccine administration codes. UniCare is not requiring authorization or referrals for members who receive COVID-19 vaccines.
For self-funded plans, claims are administered by UniCare Life & Health Insurance Company. © 2000-2021 UniCare.