Univita Quick Reference Document for Massachusetts Network Providers

Transcription

1 Univita Quick Reference Document for Massachusetts Network Providers Information: Univita Healthcare Solutions Tax ID: NPI: Payer ID: ATEND (Availity) Home Health, DME and IV Pharmacy Hours of Operations: MONDAY - FRIDAY: 9:00 AM 5:30 PM / Pharmacy until 9:00 PM / DME until 6:00 PM SATURDAY: Nursing On Call / Pharmacy until 10:00 AM - 5:00 PM / DME 9:00 AM - 5:00 PM AFTER HOURS, WEEKENDS AND HOLIDAYS ON CALL Phone Numbers: Fax: Phone: Referrals may be faxed to Univita Healthcare at any time, 24 hours a day, 7 days a week. Referral Process: 1. ALL referrals/orders must be faxed to Univita at Univita digitizes the physician orders and routes them to the network provider (This is you). Initial Authorizations: 1. Univita will provide your initial administrative authorization via fax with the physician orders. Reauthorizations: Reauthorization may be requested via Univita s eclaims portal for Pharmacy and Nursing: DME Reauthorization - for reoccurring rental items (Authorizations for 2 nd and later months rental) are handled internally. Univita verifies eligibility on a month to month basis. Provider will receive initial authorization number via fax; authorization number will be utilized for the duration of the rental period. With the following exceptions: patient becomes ineligible with the health plan patient becomes ineligible for the equipment 1

2 Supplies (Sale Items): Provider is to request authorization for supplies for each delivery Alternative methods for requesting reauthorization are as follows: Pharmacy orders/reauthorizations; fax to ; Nursing reauthorizations fax to DME Reauthorizations fax to *Services must NOT be provided until additional authorizations have been confirmed. Notification of Delivery: 1. DME providers are required to notify Univita when orders have been delivered or service provided. Procedures are as follows: DME: Via the web portal ( Delay in Service: 1. Any delay in service (services or equipment that is provided outside of the times set in the service standards listed at the end of this document) MUST be communicated to Univita. If a delay in service occurs, the process for notification is a follows: a. Pharmacy: Fax notification to (The form follows at the end of this document). b. Nursing: Fax notification to (The form follows at the end of this document), or via the web portal ( c. DME: Fax notification to (The form follows at the end of this document). ALSO call in to for any STAT delays. Billing and Claims: 1. All claims must be submitted on approved red/cms 1500 claim form, or via Univita s eclaims portal at If you are using practice management software to submit claims electronically, your system needs to be set up with the payer ID ATEND (Availity). All nursing claims must have must have nursing and therapy notes attached. All pharmacy claims require submittal of compounding sheets and proof of delivery. Fax number for submittal is: Billing Codes: Only contracted procedure codes and authorized services will be paid. Provider must only use procedure codes and HCPCs codes that are detailed on the contract or Letter of Agreement. 3. Claims submission address (for paper claims): Univita Health, Inc. ATTN: Claims Dept Commerce Parkway Miramar, FL

3 FAQ & Who Do I Call? Pharmacy IV Medications Damaris Arias (954) darias@univitahealth.com -Intake Inquiries Christian Rangel (954) crangel@univitahealth.com Authorization Inquiries Sandy Smilanich ssmilanich@univitahealth.com General/Administrative Inquiries Home Health Services Skilled Nursing or Therapies Shellie DaCosta (954) sdacosta@univitahealth.com Danielle Revales (954) drevales@univitahealth.com DME (authorization Inquires) Adriana Yorro (754) ayorro@univitahealth.com Eileen Hernandez (305) ehernandez@univitahealth.com Damaris Monzon (954) dmonzon@univitahealth.com TPA (Claims Inquires) Claim Status (954) x Jorge Bustillo (954) jbustillo@univitahealth.com Todd Waguespack (954) twaguespack@univitahealth.com Network Ana Rodriguez (754) arodriguez3@univitahealth.com Contacting Specialist / Network Provider Relations Christopher Rodriguez (954) crodriguez2@univitahealth.com - Credentialing Heather McAllister-Patel (754) hmcallisterpatel@univitahealth.com Network Operations Manager Network Contact: providernetwork@univitahealth.com 3

4 Univita s Service Standards: STAT orders Referral source MUST note as STAT to alert intake coordinator Service Standards for Services: RN Evaluation: 24 hours from receipt of clean order and clinical review, unless specific medication given or a specific start of care is needed. PT/OT/ST Evaluation: hours after clean order and clinical review. IV with nursing: As ordered by the Physician or within 4-6 hours from receipt of a complete and verified order or when next dose is due. (whichever is less) Nursing & Infusion Services: TPN, within 6 hours from receipt of complete physician s order and clinical review. All requests for further visits must be submitted within 48 hours of initial evaluation, or 1st business day following a weekend or holiday Wound Care RN will evaluate patient need at initial assessment unless specified by physician s order. Service standards for Infusion deliveries: Nursing and Infusion Services: TPN within 6 hours from receipt of complete physician s order and clinical review. IV with nursing: As ordered by the Physician or within 4-6 hours from receipt of a complete and verified order or when next dose is due. (whichever is less) STAT deliveries: within 4 hours of clean orders Routine deliveries: Next day delivery or as scheduled with the patient Service standards for DME deliveries: DME - STAT within 4 hours Hospital Discharges: delivery within 4 hours assuming receipt of a clean order. Portable Oxygen will be delivered to the hospital for transportation Routine deliveries: Next day delivery or as scheduled with the patient Equipment required within 4 hours: Crutches Oxygen Wheelchair Nebulizer Walker Phototherapy 4

5 Notes: Custodial Care: Home health aide is not a covered benefit unless accompanied by a skilled appropriate service. Wound Care: please specify wound care needs (i.e., Supplies and wound measurement) 5

6 DME Delay of Service Report FAX: Date: Order # DME Provider (company name): Patient's Last Name: First Name: MI: Insurance Company: Date Dr. Notified, Original Visit Date: Actual Date of Visit: Reason for delay of service: Patient refused service No answer at door Patient not discharged MD appointment Other: Type of equipment to be delivered: Wheelchair Walker Bed Commode Cane/Crutches Respiratory/Oxygen OTHER DME provider name (of company) Name of Delivery Personnel 6

7 Nursing Delay of Service Notification Form FAX: Or via the web portal ( Date: Univita HH# Name of Agency: Patient s Last Name: First Name: MI: Insurance Company: Date Doctor Notified: Original Visit Scheduled: Actual Date of Visit: Reason for Delay of Service: Phone disconnected Patient not answering phone Patient not returning messages No answer at door Patient not discharged Doctor s appointment Medication not delivered Patient refused service Other: Discipline Delayed: RN Evaluation Start of Care Skilled Nurse Visit Physical Therapy Evaluation Occupational Therapy Speech Therapy Social Worker visit Home Health Aide visit Agency Signature: Print Name: 7

8 Pharmacy Delay of Service Report FAX: Date: Order # Provider (company name): Patient's Last Name: First Name: MI: Insurance Company: Date Dr. Notified, Date Time of Scheduled Product Delivery: Reason for delay of service: Patient refused service No answer at door Patient not discharged MD appointment Other: Medications / Equipment Impacted (Print Clearly): 8