medicare

Important Alerts for Doctors & Hospitals

Psychotherapeutic Medication Policy

Effective September 1, 2011, a signed informed consent form will be required for any minor under age 13 who is prescribed a psychotherapeutic medication. The informed consent will need to be completed by the prescribing physician, signed by the legal guardian/parent of the minor child and presented at the pharmacy with the original hard copy prescription.

Oncology Management Program

Effective 7/18/2011

Universal Health Care has contracted a benefit manager to assist in managing all Oncology services for our membership. This will include the application of evidence-based medicine to oncology management while eliminating fraud, waste, and abuse in the delivery of adult ambulatory cancer care.

As of 7/18/2011, all Hematology, Oncology and Related Drugs (Anti-Emetics, Growth Factors, etc.) authorization requests must be faxed to 1-877-450-5531 using the Hematology/Oncology Authorization Request Form. (This does not include Radiation Therapy/Services.)

Premier PCPs – Please enter only the office visits on the Provider Portal.

Hematology/Oncology Providers – Do not use the Provider Portal

This is a dedicated fax line for Hematology, Oncology and Related Drugs (Anti-Emetics, Colony Stimulating Factors, etc.) only. We hope to markedly improve service and authorization turn-around time so that UHC patients can receive approved treatments in a timely manner.

If a request does not meet nationally recognized clinical guidelines, the benefit manager will request additional information or initiate a peer to peer conversation with a medical reviewer who is a licensed medical oncologist. UHC will continue to produce the approval and if necessary, denial communications.

Radiology Management Program

Effective 8/1/2011

As part of our ongoing efforts to improve patient safety by reducing unnecessary testing, Universal Healthcare has partnered with HealthHelp to also reduce costs and provide an efficient authorization process for your complex radiology procedures.

Please fax the Complex Radiology Authorization Request Form to the dedicated fax number, 1-877-276-2410, when requesting authorization for Cardiac Nuclear Medicine scans, all CT, CTA, MRA, MRI, or PET Scans.

This new authorization process applies to all Medicare HMO, PPO, POS and Medicaid HMO plans in Florida, Texas and Nevada.

Universal Health Care continues to strive for Hassle Free Healthcare, and we are here to work with our providers. Please let us know if we can assist you in any way.