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.
- Member Preventative Health Guidelines
- Updated Clinical Practice Guidelines now available online
- Clinical Practice Guidelines Matrix
- November 2020 Clinical Utilization Management (UM) Guidelines
- August 2020 Clinical Utilization Management (UM) Guidelines
- May 2020 Clinical Utilization Management Guidelines
- Research & Guidelines: Drug Testing Guidelines for Substance Use Disorder & Chronic Pain
- Guidelines for Behavioral Health Screening, Assessment and Treatment
- February 2021 Clinical Utilization Management (UM) Guidelines
- May 2021 Clinical Utilization Management (UM) Guidelines
- August 2021 Clinical Utilization Management (UM) Guidelines
- November 2021 Clinical Utilization Management (UM) Guidelines
- February 2022 Clinical Utilization Management (UM) Guidelines
- August 2022 Clinical Utilization Management Guidelines
- November 2022 Clinical Utilization Management Guidelines
- Clinical Utilization Management Criteria February 2023
- Clinical Utilization Management Criteria May 2023
- August 2023 Clinical Utilization Management Guidelines
- November 2023 Clinical Utilization Management Guidelines
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.
Coding spotlights
- HEDIS ECDS Coding Booklet 2024
- HEDIS Well Child and Immunization Coding Bulletin 2024
- HEDIS Cat II Coding Bulletin 2024
- HEDIS Coding Booklet 2024
- HEDIS Desktop Reference Guide 2024
- HEDIS Coding Booklet 2023
- HEDIS ECDS Prenatal and Postpartum Care Coding Bulletin 2023
- HEDIS Well Child and Immunizations Coding Bulletin 2023
- HEDIS Desktop Reference Guide 2023 WV
- Coding Spotlight: Provider’s Guide to Properly Code Cancers
- Coding Spotlight: Hypertension ICD-10 Codes & HEDIS Quality Measures
- Coding Spotlight: Provider’s Guide to Coding Diabetes Treatment and Diagnosis
- Coding Spotlight: Flouride Varnish Treatment + Facts About Fluoride
- Coding Spotlight: Substance Abuse and Smoking
- Coding Spotlight: Obesity
- Coding Spotlight: Pregnancy 101
Provider tools & resources
- Log in to Availity
- Launch Provider Learning Hub Now
- Learn about Availity
- Prior Authorization Lookup Tool
- Prior Authorization Requirements
- Claims Overview
- Reimbursement Policies
- Provider Manuals, Policies & Guidelines
- Referrals
- Forms
- Provider Training Academy
- Pharmacy Information
- Provider News & Announcements