Eligibility, Claims and Reimbursement Resources
Check claims and eligibility information
You can access this information online or via interactive voice response (IVR)
Availity Portal – File claims and get quick online access to eligibility and claims status for your
UniCare patients. You’ll also find benefits information and the status of the yearly deductible. If you’re
not already registered on Availity, register now.
Important: Availity has replaced AccessPoint, which was retired on December 8, 2017. The Availity Portal is now
your exclusive web portal for access to all electronic tools and resources previously on the secure AccessPoint portal.
Register on Availity today.
24-hour IVR Access – Use our interactive voice response (IVR) system for claims and eligibility information for your patients who are UniCare State Indemnity Plan members.
Get detailed benefits information for UniCare members.
Check reimbursement policies
Check UniCare’s reimbursement policies and periodic updates to certain claim edits.
- Enhanced post-service review process effective April 1, 2017 –
UniCare expanded its post-service review processes to ensure that claims are in compliance with
applicable American Medical Association (AMA), Correct Coding Initiative (CCI), Current Procedural Terminology (CPT),
and applicable industry standards. To support this enhanced process we have engaged OrthoNet, a leading management
company, to provide its expertise and evaluation of post-service claims. Learn more.
- New reimbursement for PCP office visits with behavioral health diagnoses –
Effective July 1, 2016, UniCare began reimbursing primary care providers for evaluation and management office visits with
behavioral health diagnoses. Learn more.
- UniCare now reimburses PCPs for tobacco, alcohol, and substance use screenings –
See the list of covered CPT codes for these services.
- ICD-10 indicator required on paper claims –
To avoid rejected claims, be sure to fill in the ICD-10 indicator field on paper
claim forms. Learn more.
- Important Information about 2015 CPT/HCPCS Code updates and reimbursement treatment
effective January 1, 2015 (non-Medicare plans only) –
On January 1, 2015, the American Medical Association (AMA) and Centers for Medicare & Medicaid
Services (CMS) released new CPT® and HCPCS codes. Many codes released as part of their
updates will be accepted by UniCare. However, certain new 2015 codes will not be eligible for reimbursement for our non-Medicare plans only.
- ICD-10 updates
Important information about paper claims requirements –
UniCare will return incomplete paper claims submitted
on professional provider CMS 1500 Form (02/12 version) and institutional
provider UB-04 Forms. Providers should ensure that paper claims are complete and follow data element
usage, required fields, and valid code sets as defined in the National Uniform Claim Committee CMS-1500
Health Insurance Claim Form Reference Instruction Manual and the National Uniform Billing Committee
Official UB-04 Data Specifications Manual.