Meet Your Liaisons
Nalani W. Ponce
Outreach Liaison"Maintaining a positive relationship with our providers is my goal. I appreciate their continued support in providing quality care to our members."
Christopher Reyes
Physician Liaison"Supporting all physicians in the UHA network and the community at large."
Medical Payment Policies
The purpose of UHA Medical Payment Policies is to guide coverage decisions and to provide information regarding the need for prior authorization and other administrative directives. They are not intended to influence treatment decisions and do not constitute plan authorization. Medical necessity must be clear. They are not explanations of benefits.
Medical policies can be highly technical and complex and are provided here for informational purposes. They do not constitute medical advice. Medical technology is constantly evolving and these medical policies are subject to change without notice. Additional medical policies may also be developed from time to time and some may be withdrawn from use as science advances. Clinical context can be highly variable.
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- Advanced Practice Registered Nurse/Physician Assistant (APRN/PA)
- Alopecia
- Anesthesia Services for Gastrointestinal Endoscopic Procedures
- Applied Behavior Analysis for Autism Spectrum Disorders
- Artificial Disc Replacement
- Autologous Chondrocyte Implantation
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- Bariatric Surgery
- Blepharoplasty and Repair of Blepharoptosis
- Bone (Mineral) Density Studies
- Breast Cancer Imaging
- Breast Reconstruction Surgery
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- Cardiac Catheter Ablation Procedures
- Cardiovascular Disease Risk Assessment and Management Using Novel Biomarkers
- Carotid Artery Stenting
- Catheter and Surgical Ablation of Atrial Fibrillation
- Charged-Particle (Proton or Helium Ion) Radiation Therapy
- Chronic Opioid Therapy
- Clinical Trials
- Cognitive Rehabilitation and Sensory Integration Therapy
- Colonoscopy
- Colorectal Cancer Screening Payment Policy
- Complementary and Alternative Medicine
- Computerized Corneal Topography
- Conscious Sedation
- Continuous Glucose Monitoring of Interstitial Fluid
- Cosmetic and Reconstructive Surgery and Services
- Cytochrome p450 Genotyping
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- Eligibility for Dependents with Disabilities
- Emerging Technology
- Endoscopic Radiofrequency Ablation for Barrett's Esophagus
- Extracorporeal Membrane Oxygenation (ECMO)
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- Gender Identity Services
- Genetic Testing - Carrier Screening and Preimplantation Diagnosis
- Genetic Testing - Oncology
- Genetic Testing for Hereditary Breast and/or Ovarian Cancer
- Genetic Testing for Lynch Syndrome/Colorectal Cancer and Polyposis Syndromes
- Genetic Testing for Non-Cancerous Inheritable Diseases
- Global Maternity
- Growth Hormone Therapy
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- Habilitative Services
- Heart Transplant
- Hepatic Neoplasm Treatment
- Hepatitis C Treatment
- High Frequency Chest Wall Oscillation Devices
- Home Continuous Inotropic Infusion Therapy
- Home Enteral Nutrition Therapy
- Home Health Care
- Home Infusion Pain Management
- Home IV Hydration Therapy
- Home Phototherapy for Neonatal Jaundice
- Home Total Parenteral Nutrition for Adults
- Hyperbaric Oxygen Treatment (HBOT)
- Hyperhidrosis Treatment
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- Implantable Ventricular Assist Devices and Total Artificial Hearts
- In Vitro Fertilization
- Inpatient Protective Isolation
- Insulin Pumps - External
- Intensity Modulated Radiation Therapy (IMRT)
- Intensive Cardiac Rehabilitation: Dr. Dean Ornish Program
- Intraocular Lens
- Intrastromal Corneal Ring Segments for Keratoconus
- Intravascular Coronary Brachytherapy Payment Policy
- Isolated Small Bowel Transplant
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- Medical Foods for Inborn Errors of Metabolism
- Medical Necessity Decision
- Men's Preventive Health Guidelines
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- Negative Pressure Wound Therapy
- Never Events and Hospital-Acquired Conditions
- Newborn's and Children's Preventive Health Guidelines
- Non-coronary Brachytherapy
- Nutritional Counseling
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- Observation Services
- Occupational Therapy
- Office Visits and Consultations
- Open Access Hospice / Concurrent Care
- Orthodontic Services for Orofacial Anomalies
- Out-of-State Referrals for Medical Services
- Outpatient IV Anti-Infective Therapy
- Outpatient Psychotherapy Services
- Oxygen and Oxygen Equipment
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- Panniculectomy/Abdominoplasty
- Photochemotherapy
- Photodynamic Therapy for the Treatment of Actinic Keratoses and Other Skin Lesions
- Physical Therapy
- Prenatal Preventive Health Guidelines Payment Policy
- Prophylactic Mastectomy
- Prostate Cancer Treatment
- Psychological and Neuropsychological Testing
- Pulse Oximeter for Children
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- Radiofrequency Ablation of Miscellaneous Solid Tumors Excluding Liver Tumors
- Readmissions and Transfers
- Real-Time Intra-Fraction Target Tracking During Radiation Therapy
- Reduction Mammaplasty
- Residential Treatment for Chemical Dependence
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- Skin Cancer Screening
- Sleep Apnea Diagnosis
- Sleep Apnea Treatment
- Small Bowel/Liver and Multivisceral Transplant
- Specialty Drugs Payment Policy
- Speech Therapy
- Spinal and Trigger Point Injections
- Spinal Cord Stimulators for Pain Management
- Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiotherapy (SBRT)
- Surgical Treatment of Femoroacetabular Impingement
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- Telehealth / Telemedicine
- Tissue-Engineered Skin Substitutes
- Transcatheter Aortic-Valve Implantation for Aortic Stenosis
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- Varicose Veins Treatment
- Vacuum Assisted Breast Biopsy
- Virtual (CT) Colonoscopy Payment Policy
- Visual Evoked Potential (VEP)
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