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For Providers

Welcome to a special set of Web pages with valuable information just for providers affiliated with Univera Community Health. This page includes specific information available to Providers such as provider guidelines and the provider newsletter.


Adolescent BMI

The prevalence of childhood obesity is increasing at an alarming rate, putting children at risk for health problems such as insulin resistance, elevated blood lipids and increased blood pressure. The American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) recommend the calculation and recording of the body mass index (BMI) at yearly visits, to identify those children and adolescents who are overweight or are at risk for becoming overweight. A BMI calculation between the 85th and 95th percentile is considered at risk for overweight: and a BMI above the 95th percentile is considered overweight or obese. Data from medical record reviews in our community indicate that BMI is documented less than 10 percent of the time at a well child visit. We recommend that the BMI be calculated and recorded with the other vital signs.

Our goal at Univera Community Health is to assist you in providing care to your patients. The following are links to available tools to help assist you in your care.

Adolescent Chart Check-Off Tool
View the Adolescent Chart Check-Off Tool
- Word Doc

Pediatric on-line calculator is available on the following web site:
http://apps.nccd.cdc.gov/dnpabmi/Calculator.aspx

Pediatric BMI wheels are available to order:
http://www.health.state.ny.us/diseases/conditions/diabetes/docs/bmi_wheel.pdf

Sample of BMI wheel that can be ordered from the DOH:
View the Sample BMI Wheel - PDF

Pediatric growth charts are available to order
http://www.cdc.gov/growthcharts

Sample of growth chart that can be ordered from the DOH
View the Girls Sample Growth Chart - PDF
View the Boys Sample Growth Chart - PDF

Other sources of information about BMI and Childhood/adolescent obesity can be obtained from the following WEB sites
http://www.aap.org/

Thank you for your continued efforts providing quality care to adolescents and for recognizing and addressing the issues surrounding childhood obesity.


Coping with Childhood Illnesses

LogoThe CompassionNet philosophy is no child should face unnecessary pain, and all families can hold on to the hope of healing.

When a child has a potentially life-threatening illness, the family is often overwhelmed physically and emotionally. Providing the support families need during their child's illness is CompassionNet. A program recently introduced by Univera Community Health, CompassionNet coordinates comprehensive services for Western New York children with serious health conditions and their families.

The program is open to Univera Community Health members. Although families insured by Univera Community Health already have access to excellent medical care if a child becomes very ill, CompassionNet takes that care one step further.

CompassionNet substantially expands the scope of care for very sick children and provides assistance for their families. Physicians, nurse practitioners and other health professionals may make referrals to the program.

Unlike traditional hospice care, CompassionNet accepts patients who may experience full recovery and doesn't restrict life-prolonging treatments. The program's philosophy is that no child should face unnecessary pain, and all families can hold on to the hope of healing.

A CompassionNet case manager develops an individual plan of care for each enrolled child and his/her family. The case manager coordinates social and support services beginning at diagnosis and throughout the course of the child's illness - even if those services may not be a benefit under the family's health plan. Before CompassionNet, few seriously ill children were able to receive this kind of "all-inclusive coordination of care" that combines institutional and community-based services. For one family, it may mean arranging for a child undergoing chemotherapy to have a wig, while for another it is securing counseling for the child's siblings.

Little Things Make All the Difference
Little things seem to make the biggest difference. One child's parents just wanted respite, for an evening out by themselves. For another family, it was having their child's blood drawn at home and avoiding long, frequent journeys to the hospital. And for one mom, it was seeing her daughter, who was in constant pain, receive a massage and then smile in momentary relief.

Families report that CompassionNet has offered tremendous comfort during their time of need by providing a community support network that helps them cope with their child's serious health condition and treatment.

The CompassionNet case management program is accepting referrals from community pediatricians and pediatric specialists. Physicians may make a referral to the program by calling (716) 857-6211 or toll-free at 1 (877) 741-3915.


Family Health Plus Benefit Changes

On September 1, 2005, New York State has changed eligibility and benefits for Family Health Plus members. Please see the grid for more information - PDF.


Child Health Plus and Family Health Plus
Pharmacy Information


Prescription Drug References and Forms
View the complete list on univerahealthcare.com


Some benefits may require medication be obtained through participating specialty network pharmacies including CuraScript Pharmacy and Priority Healthcare.
View the complete list - PDF

Prescription drugs and non-prescription drugs
View the Formulary Guide - PDF

Quality Care Dosing under the CHP and FHP Formulary Guide
Dose Efficiency List - PDF


Forms for Providers

Use the links below to print copies of our most frequently used forms.

Administration
Advance Directive Medical Record Notification Form - PDF
PCP CHange Form - PDF
Provider Information Update Form - PDF

Ancillary Services
Home Care Authorization Form - PDF
Home Care Infusion Therapy Authorization Form - PDF
Home Care Rehabilitation Authorization Form - PDF
Home Care Rehab Tip Sheet - PDF
PT/OT Initial Authorization Form - PDF
PT/OT/ST Tip Sheet - PDF
PT/OT Patient Progress Report Form - PDF
Speech Therapy Visit Report Form - PDF

Benefits Management
Care Options Alternative Care Solutions - PDF
Care Options Inclusion Criteria - PDF
Imaging Studies Tip Sheet - PDF
Outpatient Procedure List - PDF
Preauthorization for Imaging Studies Form - PDF
Preauthorization for Medical Necessity - PDF

Preauthorization Requirements for Managed Care - PDF
Referral Form - PDF

Birth and Beyond
Birth and Beyond Referral Cover - PDF
Birth and Beyond Referral Form - PDF

Billing and Remittance
Claims Status Request Form - PDF
Request for Adjustment Form - PDF
Univera Clinical Editing Review Request Form - PDF

Credentialing
Credentialing Site Visit Checklist - PDF
Initial Practitioner Information Form - PDF
Registration Form for Non-Credentialed Providers - PDF
Physician Extender Agreement Registration Form - PDF

Tools for Your Office:
Utilization Review (UR) Time Frames
The following charts show the time frames for Univera Community Health decision making and member/provider notification of utilization review decisions.
UR Time Frames (PlusMed & Family Health Plus - PDF
UR Time Frames (Child Health Plus) - PDF

Radiology
MRI/MRA, CT/CTA and Nuclear Cardiology Certfication Request Form - DPF
PET scan Precertification Fax Form - PDF


Mammography

Member Brochure - UCH version
Office Poster - Caucasian version
Office Poster - African American version
Office Poster - Hispanic version
Office Poster - Asian version
Patient Appt Card - For office use
Tips Sheet for MDs
Member Brochure - Univera version


Prenatal Risk Assessment

Criteria for Consultation or Transfer of Care to OBGYN for Prenatal Patients at Risk - PDF
Criteria for Consultation or Referral for High-Risk Pregnancies - Quality Policy - PDF


Provider Services

If you have any questions, please contact Provider Services at
(716) 857-4444 or toll free at 1 (800) 617-1114.


Provider Guidelines

The Univera Community Health Provider Guidelines are prepared through a committee structure that includes input from the physician community to establish evidence-based clinical guidelines and standards.

Guidelines are reviewed on a routine schedule, at which time any new evidence is incorporated. The following files are all PDF documents.

Cardiovascular Disease
Depression
Diabetes 
Generalized Anxiety Disorder
HIV Guidelines 
Hypertension
Preventative Heath Services: Healthy Children to Age 19
Preventive Care for Adults Ages 19 Years and Older
Treating Tobacco use and Dependence


Tools for Your Office

Preauthorization Guidelines (Effective April 1, 2006)
The following guidelines apply to all members of Univera Community Health. Some member contracts may have other restrictions.

Preauthorization Guideline - PDF

Outpatient Procedure List (Effective April 1, 2006)
The following services have been classified as most appropriately delivered in an outpatient setting. If these services are performed on an outpatient basis, preauthorization is required.

Outpatient Procedure List - PDF


Univera Community Health Provider Manual (New)

See the Univera Community Health Provider Manual online at univerahealthcare.com.


WNY Examiner

WNY Examiner with Univera Community Health Insert, Winter 2008 - PDF


WNY HealtheNet

height=25WNYHealtheNet delivers patient information to the healthcare community by leveraging shared infrastructure, technology and intellectual capital.

 

 

 

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