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Medical Policies and Clinical UM Guidelines

Updates effective March 2018

UniCare 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 our medical policies and clinical UM guidelines.

The UniCare State Indemnity Plan follows all medical policies and certain adopted clinical UM guidelines. These policies are updated quarterly, so please check back periodically for changes.

Recent Updates

Review all medical policies and clinical UM guidelines.

Prepayment Review program

UniCare has processes to review claims before and after payment, to detect fraud, waste, abuse and other inappropriate activity.

As part of UniCareís Prepayment Review program, clinical guidelines approved by the Medical Policy and Technology Assessment Committee, but not included in this standard adopted list, may be used to review a providerís claims. This may occur when a providerís billing practices are not consistent with other providers in terms of frequency or in some other manner. It may also occur when there is a need for provider education. In such instances, the clinical guidelines used for review of these providers are ďadoptedĒ for those indicated purposes.

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For self-funded plans, claims are administered by UniCare Life & Health Insurance Company. © 2018 UniCare