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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.
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 Pediatric on-line calculator is available on the following web site: Body Mass Index Screening Tools: Pediatric growth charts are available to order Other sources of information about BMI and Childhood/adolescent obesity can be obtained
from the following WEB sites Thank you for your continued efforts providing quality care to adolescents and for recognizing and addressing the issues surrounding childhood obesity. CareCore Radiology - Effective, August 1, 2008 • Univera
Healthcare Radiology Services Frequently Asked Questions Q. Who do I contact if I have a problem with the CareCore National Web site? Care Management Programs Available Knowing that helping your patients achieve optimal health helps you too, Univera Community Health offers several free Care Management programs to members. Our Health Promotion, Case and Disease Management programs can help our members and their families comply with your treatment plans, resulting in improved outcomes. In addition, our Case Managers can identify community resources and assist members in accessing and coordinating their health care services. Providers may refer members into one of our care management programs by emailing a referral to UniveraCommunityHealthProviderOutreach@univerahealthcare.com. A care manager will contact the member and ensure they enroll in the most appropriate program. Care Management Referral Form (PDF) Coping with Childhood Illnesses
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 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. Pharmacy Information for Child Health Plus, Family Health Plus and PlusMed Members
Formulary Guide for Child Health Plus (PDF) Use the links below to print copies of our most frequently used forms. Administration Ancillary Services Benefits Management Birth and Beyond Billing and Remittance Credentialing Tools for Your Office: Fraud, Waste and Abuse Information Overpayment
Self Disclosure Signed July 2012 (PDF) Member Brochure (PDF) - UCH version Medical and Administrative Policies Medical & Administrative Policies for Providers on the Univera Healthcare web site Partnering to Achieve Quality (PAQ) - Physician Quality Improvement Programs Performance Improvement Coaching (PIC) Program Office Based Quality Improvement Contact Us If you have any questions, please contact Provider Services at: Clinical Practice Guidelines are evidence-based statements and recommendations designed to assist clinicians by providing an analytical framework for the evaluation and treatment of patients. While they should be followed in most cases, there is an understanding that, depending on the patient, the setting, the circumstances, or other factors, care can and should be tailored to fit individual needs. Clinical guidelines are based on the most current scientific evidence, and are adopted or adapted from standards published by recognized sources. Each guideline is reviewed and updated by Health Plan staff and approved at least every two years by the plans' Quality Management Committee. These guidelines are not a statement of benefits. Benefits may vary. Individual coverage will need to be verified by the Plan.
ADHD Guideline - Adopted from the American Academy of Pediatrics December 2011. Next review December 2013. Preventive Care of Healthy Children to Age 19: Practice Guideline
Adopted April 2011. Next review April 2013.
Univera Community Health has adopted specific screening and testing requirements for lead and HIV as
per the New York State Department of Health requirements. Follow these links for the specific testing
requirements:
Univera Community Health has adopted the U.S. Preventive Services Task Force screening recommendations
for depression screening in children and adolescents. Follow these links for the specific recommendation
statements.
Preventive Care of Adults Ages 19 and Older: Practice Guideline
Adopted April 2011. Next review April 2013.
Univera Community Health has adopted specific screening and testing requirements for HIV as per
the New York State Department of Health requirements. Follow these links for the specific
testing requirements:
Serious Adverse Events/Other Provider-Preventable Conditions As outlined in the quality policy, the coverage and reimbursement criteria applicable to Serious Adverse Events/Other Provider-Preventable Conditions and Hospital Acquired Conditions/Health Care-Acquired Conditions that occur in a hospital setting is addressed. As part of Health Plan's Quality Improvement Program, this quality policy is consistent with the development of other programs designed to assure quality of care. Serious Adverse Events Policy (PDF) - Effective January 1 2010 Preauthorization Guidelines 2012 Preauthorization Guideline (PDF) Outpatient Procedure List 2012 Outpatient Procedure List (PDF) Univera Community Health Provider Manual (New) See the Univera Community Health Provider Manual online at univerahealthcare.com. WNY Examiner with Univera Community Health Insert,
Winter 2013 (PDF)
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The CompassionNet philosophy is no child should face unnecessary pain, and all families can hold on to the hope of healing.
