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Managed Care Notification Requirements
The Managed Care Program for the UniCare State Indemnity Plan includes Utilization Management, Medical Case Management
and Quality Centers and Designated Hospitals for Transplants.
The purpose of the Managed Care Program is to review clinical information and to determine the medical necessity and
appropriateness of certain health care services based on Plan coverage. This process ensures that benefits are used appropriately and lets
you know in advance what services will be covered.
The process is initiated when you or someone on your behalf notifies the Andover Service Center of a hospital
admission or health care service listed in the notification requirements section. Different notification requirements
apply, depending on the plan in which you are enrolled.
Who Is Responsible for These Notification Requirements?
If you are enrolled in the UniCare State Indemnity Plan, you are responsible for complying with the
Plan's notification requirements. If you fail to notify the Andover Service Center within the
required time frames, your benefits may be reduced or denied.
However, if you are a member of the PLUS Plan and use a PLUS provider in Massachusetts, that provider is responsible for the Plan's notification requirements. This means you do not have to contact the Plan yourself.
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