Frequently Asked Questions

Where can I locate Plan documents?

On the Universal website, all of our Medicare Plan documents are available in the Plan Documents section. You can also contact us if you have any questions.

When should I expect my ID card to arrive?

You will receive a Universal Health Care (UHC) ID card after the Centers for Medicare & Medicaid Services (CMS) accepts you into the requested plan. Once you are accepted, your ID card will be generated in 24 to 48 hours. You will receive your card within 7 to 10 business days after that. The entire process typically takes 2 to 3 weeks after the date the application was filled out. However, during the busy enrollment season, these times may be extended.

Why is my membership pending?

Your Member status may be pending for several reasons including:

• Incomplete information on your application
• CMS has not processed and approved the application

As soon as the application is processed by CMS, Universal will update the status and activate your membership.

What should I do if I have not received my ID card but I need to access services (and it is after my effective date)?

Pending Members have full use of benefits after their effective date. If your membership is still pending after the proposed effective date, you can utilize the UHC acknowledgement letter you received in the mail or your copy of the application as proof of enrollment. Your Provider or pharmacy can contact Provider Services at 1-877-661-3920 (TTY 1-800-617-0177) to verify coverage, 8:00am-5:00pm EST, Monday-Friday

Can I print a temporary ID card?

Yes! Once you're approved as a Member, you can print a temporary ID card that you can use immediately. This can be done by accessing our Member Portal at www.univhc.com. Please follow the instructions below for printing a temporary ID card.

• Go to www.univhc.com.
• Under Medicare, select the Member Login link.
• New Members will first need to register to create a username and password.
• Enter username and password.
• Select Coverage and Benefits.
• Select the link that says "Click here to print a Temporary ID Card online".
• To print a temporary card, select the "Print" button.

I received my ID card but did not get my New Member Kit. Will I get a New Member Kit soon?

Yes. ID Cards are sent out separately. You should receive your New Member Kit approximately 1-2 weeks after your application is approved by CMS.

What is included in the New Member Kit?

The New Member Kit includes:

• A welcome letter
• HIPAA Privacy Form
• Prescription drug forms (MAPD plan Members only)
• Pharmacy survey with return envelope
• Low Income Subsidy (LIS) Rider, when applicable
• Evidence of Coverage (EOC)
• Provider Directory (network plan Members only)
• Pharmacy Directory (MAPD plan Members only)
• Formulary  (MAPD plan Members only)
• United Medco Part B Diabetic Supplies letter
• Private Fee-For-Service (PFFS) “Dear Doctor” letter for PFFS Members
• PFFS Member letter for PFFS Members
• Special Needs Plan (SNP) welcome letter for Members of our SNP plans
• Magnet (with the Member Services and 24-Hour Nurse Hotline phone numbers)
• VitalifeSM rewards flyer
• SilverSneakers® flyer
• Calendar

I was told that my enrollment application is incomplete or denied. How do I know if the enrollment will go through? What do I need to do?

Call Member Services at 1-866-690-4842 (TTY 1-800-617-0177) 8:00am - 11:00pm EST, Monday - Friday.

When and where can I get my prescriptions?

You can fill prescriptions as soon as your coverage is effective at any network pharmacy. To find out which pharmacies operate within Universal's network, please refer to the Pharmacy Directory you received in your Member kit, or you can access it online.

What if I need to get prescriptions and I have not received my ID card yet?

You can access your prescription drug coverage by providing your UHC ID number, along with your BIN, PCN, and Group information to the pharmacy. This information is also included on your Acknowledgement Letter.

Example:

• PCN - MEDDPRIME
• BIN - 610014
• Group - Univers Return to top

The pharmacy says I am not showing as an active Member.

You or your pharmacy can verify your enrollment by calling Member Services at 1-866-690-4842 (TTY 1-800-617-0177) 8:00am - 11:00pm EST, Monday - Friday.

What if my drug is not in the Formulary?

Within the first 90 days of your enrollment into our plan, UHC will allow up to a 31-day temporary supply to be provided of non-Formulary Part D drugs in order to accommodate your immediate needs. This will also allow UHC and you sufficient time to work with the prescriber to make an appropriate switch to a therapeutically equivalent medication from the Formulary, or to complete an exception request, to maintain coverage of an existing drug based on medical necessity.

What coverage restrictions apply?

When you are obtaining a temporary supply of a non-Formulary drug, or one that has coverage restrictions or limits but is otherwise considered a Part D drug, we will cover a 31-day supply (unless the prescription is written for a shorter period of time) but generally will not pay for them again as part of our transition policy. A written notice will be sent after your temporary supply has been covered. The notice explains the steps to request an exception and how to work with your doctor to decide if you should switch to an appropriate drug that we cover.

Where can I get my diabetic supplies?

UHC has partnered with United Medco to provide your diabetic supplies. United Medco will provide the following Part B diabetic supplies:

• Glucose meter/monitor
• Test strips
• Lancets
• Lancing devices
• Insulin syringes
• Insulin pen needles

To find out more about how to fill your prescription for Part B diabetic supplies, contact United   Medco at 1-800-881-6325 (TTY 1-866-774-8167) 8:00am - 11:00pm EST, Monday - Friday.

What do I do if I have Durable Medical Equipment (DME) that needs to be exchanged?

Members should be aware that current DME or oxygen will not be removed until replacement DME from UHC is received.  

Please have your primary care physician (PCP) call EMP (Universal’s DME provider) at 1-800-225-6755 to assist with facilitating the transition. Your doctor will be required to submit an authorization to EMP for approval of the DME or oxygen. If you have not seen your doctor yet, please call Member Services at 1-866-690-4842 (TTY 1-800-617-0177) 8:00am - 11:00pm EST, Monday - Friday.

For PFFS Members: If you have a PFFS plan, you will continue to receive equipment through Medicare-participating Providers.

How do I access my gym membership?

You will receive a SilverSneakers® brochure showing participating locations, addresses, phone numbers, and amenities.

You can also access this information by going to www.silversneakers.com or calling SilverSneakers® at 1-888-423-4632 (TTY: Relay 711) 6 AM – 6 PM Mountain, Monday-Friday.

How do I sign up at a gym?

To join a gym, you will need to:

Bring your UHC membership ID card and photo ID to a participating gym location.
Ask to speak with a Senior Advisor. He or she will walk you through the enrollment process, which includes filling out an enrollment packet and an Activity Readiness Assessment (a questionnaire that determines clearance for exercise).

Once you are enrolled, the staff will place a SilverSneakers® sticker on your UHC ID card.
If you need medical clearance, you will be given further instruction and clarification during your enrollment visit with the gym’s Senior Advisor. Before you join, you may also bring to the gym a note from your doctor saying that it’s okay for you to participate in the SilverSneakers® program.

I received a statement from the Social Security Agency (SSA) and it is not reflecting my Part B buy down/Reduction. The amount I thought I qualified for is not the same as on the statement. What should I do?

Call our Member Services department at 1-866-690-4842 (TTY 1-800-617-0177) 8:00am - 11:00pm EST, Monday - Friday. If you qualify for the reduction, it will be reflected in your SSA deductions in 2012.

I was disenrolled but would like to remain a Member of Universal Health Care.

We are glad to keep you as a Member! Verbal requests for reinstatement may be taken over the phone as long as the call is within 30 days of the disenrollment notice and you have not used the services of any other Managed Care Organization (Unless it was used in case of emergency). Call our Member Services Department at 1-866-690-4842 (TTY 1-800-617-0177) and request to be reinstated. If it is after 30 days, you will need to complete a new application as the request for reinstatement is no longer valid.

I no longer want to be a Member of the plan. What do I do?

We are sorry if you no longer want to be a plan Member. Please call our Member Services department at 1-866-690-4842 (TTY 1-800-617-0177) 8:00am - 11:00pm EST, Monday - Friday and they will help you. You may also write to us with your request or send a fax.

Mail:

• Universal Health Care
• Attn: Enrollment Department
• 100 Central Ave, Ste 200
• Saint Petersburg, FL 33701

Fax: 1-727-497-0664

Last year I was able to change to another MAPD plan, as long as it was similar to my current plan. Why can I no longer make this change?

For 2012, OEP (Open Enrollment Period) no longer exists. OEP has been replaced with a period known as Medicare Advantage Disenrollment Period (MADP).This new period is from January1 through February14.  The MADP does not provide an opportunity to join or switch Medicare Advantage plans. With this new period, you can disenroll only to return to Original Medicare.

However, you may add a stand-alone Prescription Drug Plan (PDP) to Original Medicare during this period (known as a Special Enrollment Period or SEP).

I had surgery during enrollment with my prior plan and need to complete treatment. Is this covered? What do I need to do?

If you need to continue treatment, you are covered under "continuity of care." You may need to have your treating physician submit an authorization request, along with the medical documentation for continuity of care, to the Care Management Department. Please call our Member Services department at 1-866-690-4842 (TTY 1-800-617-0177) 8:00am - 11:00pm EST, Monday - Friday for more assistance.

Upon enrollment, my Power of Attorney (POA) information was provided. Why is it not on record?

Please call our Member Services department at 1-866-690-4842 (TTY 1-800-617-0177) 8:00am - 11:00pm EST, Monday - Friday for more assistance. The POA can also be faxed to UHC at fax # 727-497-0664

How do I submit a refund request?

It is important, in order to allocate proper payment and benefits to the member, that we receive a typed HCFA-1500 or UB04 Form when services are performed. If a superbill is sent, it must include all fields which are offered on a HCFA-1500. For example a superbill does not have an option for the NPI#. This is important as this verifies they are a Medicare Certified Provider and it will also help gauge payment amount. HCFA-1500 is available on the internet or the member may request one from their physician/ hospital - UB04. Members may submit an appeal once the appropriate documentation is received.

• Typed HCFA-1500 or UB04
• Superbill - must include all fields which are offered on a HCFA-1500
• Medicare Certified Provider
• Member must also include proof of payment
• Mail to the corporate office address:
  
  Attn: Member Reimbursement
  100 Central Ave., Suite 200
  St. Petersburg, FL 33701

How can I update my mailing address or e-mail address?

Log in as a Member on our website. Select the "User Profile" link to change your mailing or e-mail address. If you need help, please call Member Services at 1-866-690-4842 (TTY: 1-800-617-0177) from 8:00am - 11:00pm EST, Monday-Friday. Next, go to DCF Access Florida at www.dcf.state.fl.us/ess/ or call DCF at 1-866-762-2237(TTY 1-800-955-8771). Tell them about your address change.

What should I do if I move?

You will need to update your mailing address online. You must also contact DCF Access Florida online at www.dcf.state.fl.us/ess/, or call DCF at 1-866-762-2237 (TTY 1-800-955-8771). Tell them about your address change.

How can I get a replacement ID card?

Log in as a Member on our website. Select the "Request ID Card" link. Print a temporary ID card online. You can also ask for a permanent ID card.

Can I see my benefits online?

Yes, go to the Universal website home page. Select the Universal "Plan Benefits" link under Medicaid.

Who takes care of my dental coverage? How can I find a dentist?

Universal gives you dental coverage with Managed Care of North America (MCNA). Visit MCNA online at www.mcna.net. You can also call MCNA Member Services at 1-877-261-2155 (TTY 1-800-955-8771). For children under the age of 20 who do not live in Broward or Duval Counties, please call the Medicaid office nearest you. They will help with your benefits. Return to top Learn more about MCNA

Who takes care of my behavioral health coverage? How can I find a Behavioral Health doctor?

Universal gives you behavioral health and substance abuse coverage with Comprehensive Behavioral Care (CompCare). Learn more about CompCare

Who takes care of my vision coverage? How can I find a vision provider?

Universal gives you vision coverage with Advantica Eye Care. To find an Advantica provider in your area, please visit www.advanticaeyecare.com. You can also call Advantica Eye Care Customer Service at 1-877-261-2156. Learn more about Advantica Eye Care

I need laboratory work completed. Where should I go?

Universal works with all Quest Diagnostics Laboratories throughout the State. To find one near you, please call Quest Diagnostic Customer Service at 1-800-282-6613.

How can I change my primary care provider (PCP)?

Log in to our website as a Member. Go to the "Provider and Facilities" link. Select the doctor you want. This will change your doctor. Or please call Member Services at 1-866-690-4842 (TTY: 1-800-617-0177) from 8:00am - 11:00pm EST, Monday-Friday.

What if my doctor leaves your plan?

A network doctor you are using may leave the Plan. If this happens, you will have to change to another doctor who is part of our plan. Universal will notify you should your provider leave the Plan. You may change your doctor online.

• Log in to our website as a Member.
• Go to the "Providers and Facilities" link.
• Select the doctor you want.

Do you have bilingual providers?

Yes, please go to the Provider Directory. You can find it under the "Find a Physician" link. Under the name of each doctor, the languages they speak are listed.

What is covered in an emergency situation?

If you are in need of emergent care, call 911. You can also go to the emergency room. You do not need authorization first. It is not needed for emergency room services. If you are not having an emergency, please schedule an appointment with your doctor. You can also call our Nurse Hotline at 1-877-810-4236 (TTY 1-800-617-0177). You can get covered emergency medical care when you need it. You can get it anywhere in the United States. You can also get medical help and information by calling our Nurse Hotline. It is open 24 hours a day, every day of the week. This service is at no cost to you.

How do I login to the provider portal of the website?

Click on Login under the "Doctors and Hospitals" link of the Home page. If you have a current username and password, enter it in the space provided and click "Submit." If you are a non-contracted or contracted PFFS-only provider, click on the "New User Registration" and a username and password will be sent to you via email. Currently, non-par and contracted PFFS-only providers have access to Member Eligibility only.

I forgot my password; how can I reset it or have a new one sent to me?

Please send a request to providers@univhc.com with your username or other identifying information (i.e., TIN, NPI, etc.)

How do I check eligibility and benefits of a Member?

After logging in to the provider portal, click on the "Eligibility Check." Enter the Member's name, DOB, and either the Member ID number or the SSN. Please note that Members are not required to supply Universal with their SSNs, so not every Member will have one in our system.

Where can I find samples of Member ID cards?

Copies of ID cards, along with a description of the plan, are located in your state's Provider Quick Reference Guide, which is available by clicking on the "Doctors and Hospitals" link of the Home page and then by clicking on the link located under "Resources."

How do I view my (PCP) member panel?

After logging in to the provider portal, click on "Member Report." Select the line of business (or all) to view a listing of Members assigned to you.

What is Universal's payer ID number for electronic claims?

Universal's payer ID number is 50528.

How do I view the status of the claims I have submitted?

After logging in to the provider portal, contracted providers* can click on "Claims Status." You may search by Member name, ID number, Date of Service, etc. Click on "View Report" or "Print Report" at the bottom of the screen for claim information, including the check number/date/total. You can also run reports by plan type or CPT code and export them to Excel.

*Claims viewing ability is currently unavailable to non-contracted and contracted PFFS-only providers, but will be available soon.

How do I appeal a claim determination?

If you are a contracted provider, you may fax a Contracted Provider Claims Reconsideration Form and supporting documentation to the Claims Department. The form is located in the Provider Quick Reference Guide, which is available by clicking on the "Doctors and Hospitals" link of the Home page and then by clicking on the link located under "Resources." For non-contracted providers, please follow the instructions on the back of the Remittance Advice.

How do I request an authorization if a plan requires one?

After logging in to the provider portal, contracted providers can click on "Request Authorization." Open Access Plans – Fill in the information requested, print the form (BEFORE clicking on Submit), and fax the form with the clinical information to our UM department at 1-866-420-4842. A reference number will appear after you submit the form online. Check the "View Authorizations" link for the status of your request. Florida Premier Plans – The authorization number will appear once the request is entered if you are the Premier Member's PCP.

How can I check the status of an Authorization Request?

After logging in to the provider portal, contracted providers can click on "View Authorizations." The status of all processed authorization requests will appear as Pending/Approved/Denied/Closed. View authorizations by name or scroll through the listing. Click on "Select" under the "View" column for details.

NOTE: Authorization Requests will appear ONLY if the request was initiated online. You may fax an Authorization Request directly to UM, but the status will not appear online.

Which services or procedures require authorizations?

Please see the Authorization Guidelines for the Member's plan in the Provider Quick Reference Guide, which is available by clicking on the "Doctors and Hospitals" link of the Home page and then by clicking on the link located under "Resources."

Where do I send patients for labwork?

Universal Health Care's contracted lab is Quest Diagnostics.

How do I update my practice, correspondence, or billing address; Tax ID #, and/or phone numbers?

Please send a written request to Universal Health Care, Attention Provider Operations, 100 Central Avenue, Suite 200, St. Petersburg, FL 33701. Tax ID and billing address changes must be accompanied by a W-9 matching the new address.

Is there a Provider Administration Manual available on your website?

The Provider Administration Manuals are located by clicking on the "Doctors and Hospitals" link of the Home page and then by clicking on the link located under "Resources." Please also see your state's Provider Quick Reference Guide for easy access to the most up-to-date information and forms. No login is required.

How do I become a provider for Universal Health Care?

Please fill out the Join Our Network form.