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Reimbursement Policies

Updated May 2023


These policies serve as a guide to help providers submit claims correctly and to outline the basis for reimbursement if the service is covered by a UniCare member's benefit plan. Please see the individual policies for more details on requirements and updates, which will be posted as they become available.

In October 2021 UniCare implemented a commercial reimbursement policy titled ‘Sexually Transmitted Infections - professional’ would be effective for dates of service on or after December 1, 2021. UniCare has made a decision to retract this reimbursement policy.

UniCare’s New Reimbursement Policy onFee Schedule Development and Maintenance

UniCare uses commercially reasonable efforts to update all applicable new and updated codes within 60 days of release by the Centers for Medicare & Medicaid Services or other applicable authority. When billing codes are updated, the provider is required to use appropriate replacement codes for claims for covered services.

Reimbursement Policy on Fee Schedule Development and Maintenance

Global Surgical Reimbursement Methodology – Facility

Claims submitted with surgical codes that are on the Global Surgical fee schedule will be reimbursed based on the family cluster of the code and the scheduled allowed rate using certain methodology.

Global Surgical Reimbursement Methodology – Facility

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