Resources for Providers

Here is a list of helpful resources regarding the status of claims, provider searches, benefits, notification requirements and other important Plan information.

Notification Requirements - Find out which procedures require pre-notification and how much notice is required. View and print pre-certification worksheets.

File Claims Electronically - Get details on how to send claims to the Plan electronically.

Reference Sheet for Contracted Providers - If you are a contracted provider for the UniCare State Indemnity Plan, use this sheet as a convenient reference for member copays, managed care notification requirements, selected procedures for pre-review and preferred vendors. Please refer to the applicable Member Handbook for more information on Plan benefits, conditions, limitations and exclusions.

PLUS Provider Directory - Do a provider search to find the names of PLUS providers to whom you can refer your PLUS Plan patients to ensure that they receive the highest possible coverage under the UniCare State Indemnity Plan.

Preferred Vendors - Get a list of contracted providers for the services listed below to be sure you are referring your patients to a contracted provider so they get 100 percent coverage for these services (versus 80 percent coverage with other vendors). For other providers, click on the link above for the PLUS Provider Online Directory.

• outpatient laboratory services
• home health care
• home infusion therapy
• medical supplies
• diabetic supplies
• durable medical equipment
• therapeutic air flow pressure relief mattresses

Benefit Descriptions - Get detailed information on certain member benefits such as cardiac rehabilitation programs, infertility services, skilled nursing facilities, preventive care and more. Please refer to the applicable member handbook and benefit update for more information on Plan benefits, conditions, limitations and exclusions.

View Member Handbooks & Benefit Updates - Search for information in the Plan's member handbooks and benefit updates.

Hospital Safety Initiatives - Medical errors in hospitals are more prevalent than you may realize. The Institute of Medicine reports that many of these errors are preventable. In response to this problem, the Leapfrog Group has developed four initiatives to help hospitals reduce preventable medical mistakes. Leapfrog's newest "leap" - the Leapfrog Quality Index - summarizes how well a hospital adheres to 27 practices known to reduce medical errors. Learn about Leapfrog's initiatives and find out which hospitals use these key safety practices to protect patients. This information will also help you select a hospital for your patients.

Contact Us - E-mail us or get contact information for the Plan, Express Scripts and United Behavioral Health.

Get 24-hour Access to Claims and Eligibility Information with Our IVR System
Our interactive voice response (IVR) system gives providers access to claims and eligibility information about Commonwealth Indemnity Plan members whenever it's most convenient. All you need is your tax ID number (TIN) and the member's ID number.

To access the IVR:

• Call 1-800-442-9300 (our Customer Service phone line)
• Press 2 to access the provider menu
• Press 1 to access the automated system
• Enter your TIN and the member's ID number at the prompt, select the member you are calling about, and choose one of the following options:



Press 1 for a fax back with member eligibility and benefits, or
Press 2 for verbal confirmation of the member's coverage and benefits, or
Press 3 for information on the status of processed claims