Provider manuals, policies and guidelines

UniCare Health Plan of West Virginia, Inc. (UniCare) is committed to supporting you in providing quality care and services to our members. Here you will find UniCare’s provider manuals, guidelines for clinical Utilization Management (UM), medical policies and coding spotlights for common conditions.

Provider manuals

UniCare’s provider manuals provides key administrative information, details regarding programs that include the utilization management program and case management programs, quality standards for provider participation, guidelines for claims and appeals, coding spotlights and more.

Medical policies and clinical UM guidelines

Medical policies address the medical necessity of new services or procedures and new applications of existing services or procedures. Clinical UM guidelines focus on detailed selection criteria and location for generally accepted technologies or services.

We routinely update medical policies and clinical utilization management (UM) guidelines as part of the review process. Please visit Medical Policies & Clinical Utilization Management Guidelines: Full List on the UniCare website to view or search for specific medical policies and clinical UM guidelines.

Provider tools & resources

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We look forward to working with you to provide quality services to our members.