Provider Reference Sheet
Use this document as a convenient reference for member copays, notification requirements for preapprovals, and selected procedures for pre-review.
Please refer to the applicable member handbook, found in our member materials, for more information on plan benefits, conditions, limitations, and exclusions.
Updated July 2020
Find out which procedures require preapproval and how much notice is required.
CPAP and BPAP (for Medicare members only)
DME: apnea, cardiac, uterine and oximetry monitors
DME: compression, medication, feeding, insulin and suction pumps
DME: hospital bed/special mattress
DME: stimulator/CPM machine/TENS unit
DME: General Precertification
Home Health Care
Hyperbaric Oxygen Therapy
Intensity Modulated Radiation Therapy (IMRT) (CMBM review)
Meniscal Allograft Transplant
MRI of the Knee
Skilled Nursing Facility
Outbound Fax Information Form forUtilization Management (UM) Decision Letters
Use this form to begin receiving UniCare utilization management decision letters for approvals, denials, and requests for information by fax.
HealthCare Administrative Solutions (HCAS) Provider Enrollment Form
Use this form to enroll as a UniCare contracted provider. Please complete a separate page for all new providers in the group.
Standardized Provider InformationChange Form
If you're an existing UniCare contracted provider, use this form to let us know about changes to your practice, such as the names of new providers in your group.
Member ID Cards
View samples of the member ID cards for all four plans. UniCare ID cards show copay amounts and other plan information.