Provider Manual

We developed Unity's Provider Manual as a reference for our participating practitioners and providers. The purpose of the Manual is to inform you about Unity, our policies and procedures, our Quality Improvement (QI) Program and QI initiatives. The Manual also covers topics of importance to our providers and practitioners who render services to Unity's BadgerCare Plus (Medicaid) members.

The Provider Manual is a quick reference where you can find answers to frequently asked questions. Below is a summary of the Manual's contents.

Download the entire Provider Manual or browse sections of interest below.

Introduction
- Historical Background
- Who to Contact
Provider Relations
- Service Area Map
- Provider Changes/Forms
- Benefits Assistant
Product Descriptions
- Member ID Cards
National Committee for Quality Assurance (NCQA)
- What is NCQA Accreditation?
- Why is NCQA Accreditation Important?
Medical Management
- Medical and Behavioral Health Management
- Hospital Admissions
- Outpatient Procedures
- Concurrent Review
- Length of Stay
- Retrospective Review
Practitioner Appeals Process (for Prior Authorizations)
- Denial Appeal
- Expedited Reviews
New Medical Technology Evaluation
- Requesting a New Medical Technology Evaluation
- Evaluation Factors
Emergency Room
- Follow-Up Treatment
- Emergency Transfer
- Hospital Emergency Room Copayment
Referrals
- Out-of-Plan Referrals
- Prior Authorization
Pharmacy
- Prescription Drug Formulary
- Prescription Drug Benefits
- Quantity Limits
- Pharmacy and Therapeutics (P&T) Committee
- Review of New Drugs
- Prior Authorization and Medical Exception
Claims
- Medical Claims
- Dental Claims
- Medicare Claims
- Submissions guidelines
- Electronic Claims Submission
- Coordination of Benefits (COB)
- Remittance Advice
- Recoupment
- Subrogation
Credentialing
- Credentailing Process
- Recredentialing Process
- Practitioner Rights
- Credentialing Information Confidentiality Policy
- Physician Office Audits
Coverage
- Durable Medical Equipment (DME)
- Home Health Care
- Home Infusion Therapy
- Mental Health/Alcohol and Other Drug Abuse
- Skilled Nursing Facility
Confidentiality
- General Policy
- Release of Protected Health Information Without Authorization
- Release of Protected Health Information Requiring Authorization
- Member Access to Medical Records
- Disclosure of Information to Employers
- Treatment Setting
- Quality Improvement Measurement
Promotional Marketing Assistance
Interpreter Services
Quality Improvement
- QI Program
- Health Plan Employer and Data Information Set (HEDIS®)
- Preventive Health Care Guideline
- Continuity and Coordination of Care
- Health Management Programs
- Behavioral Health
- Clinical Practice Guidelines
- Patient Safety
Members
- Satisfaction Survey
- Rights and Responsibilities
Medical Records
- Importance of Medical Records
- Medical Record Audits
- Medical Record-Keeping Practices
- Medical Records Confidentiality
Access Standards
- Primary Care Practitioner
- Behavioral Health
After Hours Care
Badger Care Plus (formerly Medicaid/BadgerCare)
- Health Check
- Health Check Prompt
- Health Check Outreach Initiatives
- Wisconsin Women, Infants and Children (WIC) Nutrition Program
- Immunizations/Vaccinations
- Unity BadgerCare Plus Health Outreach Support Staff
- Welcome, New Members
- Transportation to the Clinic for Health Services
- Sterilization/Hysterectomy/Abortion Procedures for BadgerCare Plus Members
Appendices
- HCFA 1500 Form
- Sterilization Informed Consent Form with Instructions
- Sterilization Informed Consent Form with Instructions (Spanish)
- Acknowledgement of Receipt of Hysterectomy Information
- Abortion Certifcation Statements
Please direct operational questions to Unity Customer Service at 800-362-3310. If you have questions regarding our Quality Improvement efforts, please call Unity's Health Services Department at 800-362-3308.

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