Univera Healthcare Prior Authorization

Univera Healthcare prior authorization rules are often service-specific rather than universal, so the safest workflow is to confirm the requirement in the payer's provider resources before scheduling or submitting care. The notes below summarize the most actionable provider-side guidance captured in the research set for this payer.

At a glance

• Prior authorization is required for some treatments, medications, and procedures. Univera directs providers and members to the current prior authorization procedure code list to determine whether authorization is required. In most cases, the provider submits the request. For some PPO plans, the member may be responsible for starting the process for certain services. For medical specialty drugs, Univera instructs providers to use PromptPA for all lines of business except FEP, which continues to use CareAdvance Provider.
• Prior authorization requirements can vary by service, code, and line of business.
• Some PPO members may need to initiate authorization for certain services.
• The publicly available page does not fully expose all submission mechanics for every product.

Where to verify prior authorization requirements

• Verification resource 1
• Verification resource 2

How to submit prior authorization requests

• Provider-submitted request through the applicable authorization workflow

• PromptPA for medical specialty drug requests for all lines of business

• CareAdvance Provider for FEP members

• Phone call to Medical Intake for expedited requests with a case number

• Submission resource 1

Information commonly required

• Service/procedure code
• Member identification information
• Provider confirmation that the request has been initiated, when applicable
• Case number for expedited requests

Turnaround notes and caveats

• Univera states expedited authorization requests must be called in to Medical Intake with a case number to expedite.
• The public prior authorization page points users to current code lists rather than publishing a single universal turnaround time.
• Prior authorization requirements can vary by service, code, and line of business.
• Some PPO members may need to initiate authorization for certain services.
• The publicly available page does not fully expose all submission mechanics for every product.

Provider resources

• Provider home (official)
• Participating Provider Manual (official)
• Provider Contact Us (official)
• Prior Authorization (official)
• Provider FAQ (official)
• Provider Claims & Payments login (official)

Sources