Changes to specialist tiering
For the plan year starting July 1, 2019, UniCare will move from individual to group tiering for specialists. This means all specialists within a practice will receive the same tier placement.
Express Scripts site of care specialty pharmacy drug list effective April 1, 2019
View the list of specialty drugs that require review and dispensing by Express Scripts for non-Medicare members only. Check back for quarterly updates.
Important Information about UniCare’s utilization management process
Our UM decisions are based on the appropriateness of care and service needed, as well as the member’s plan coverage.
Enhanced post-service review process
UniCare expanded its post-service review processes on April 1, 2017 to ensure that claims are in compliance. Providers who submit addition documentation after the initial claim submission should mail it to Orthonet at the address provider in Orthonet's letter.
Availity remittance inquiry search option streamlined
We’ve changed the Check/EFT search option to make it easier for you to find your remittances.
New PCP reimbursement for certain behavioral health services
UniCare will now reimburse PCPs for tobacco, alcohol and substance use screenings, and ambulatory detoxification. See the list of covered codes for these services.
Send discharge summary for inpatient claims
Rather than send us the entire medical record for an inpatient claim, you can just send the discharge summary. We’ll contact you if we need more information.
Expansion of specialty pharmacy prior authorization list
Effective for dates of service on and after May 1, 2019, certain specialty pharmacy codes from new clinical criteria or current clinical guidelines will be included in our pre-service review process.
Clinical criteria updates for specialty pharmacy
Effective for dates of service on and after March 1, 2019, new clinical criteria will be included in our clinical criteria review process.
Resources for behavioral health providers
Get information about preapproval notifications, claims filing and processing, credentialing, and more.
Updates to AIM guidelines for cardiac imaging
Beginning with dates of service on or after January 28, 2019, AIM Specialty Health® is revising its guidelines for certain cardiac imaging procedures.
New EDI gateway for submitting claims directly to UniCare
Availity is now UniCare’s designated EDI gateway for both medical and behavioral health claims. Register on Availity today.
Quality Centers and Designated Hospitals for Transplants
Our program offers quality, cost-effective services to eligible non-Medicare members. Get details about the program and check our listings of participating providers.
HCAS provider enrollment form
Use this form to apply for credentialing to become a UniCare contracted provider.
Standardized provider information change form
Use a standardized provider information change form to let UniCare know about changes to your practice.
Patient-Centered Primary Care Program (PC2)
Learn about our innovative program to promote coordinated, evidence-based care aimed at improving quality, patient experience and affordability.
Check out our tools and resources to help your practice get started on your practice transformation journey.
Get in-depth information on each of the 10 Patient-Centered Primary Care program milestones, which are based on industry best practices.
Collaborative Learning Opportunities
These webinars offer our practices access to the most current information from the country’s leading health care experts … all in support of practice transformation and fulfilling Patient-Centered Primary Care program expectations.
Cost and Quality Resources
A directory of resources to help primary care practices committed to delivering high-quality, patient-centered care that is also efficient.