University Health Alliance (HSA) Coverage Criteria
- University Health Alliance (HSA) prior authorization
- All University Health Alliance (HSA) policy updates
Latest University Health Alliance (HSA) coverage criteria updates25
- Coverage CriteriaReimbursement/Payment PolicyEff. 2026-03-01Telehealth Services Reimbursement and Coverage PolicyDefines University Health Alliance (UHA/HSA) reimbursement, coverage criteria, limitations, and administrative billing guidelines for telehealth and telemedicine services for covered members and participating providers.All University Health Alliance (HSA) updates
- Coverage CriteriaReimbursement/Payment PolicyEff. 2022-12-01Psychological and Neuropsychological Testing reimbursementThis policy governs prior authorization, medical necessity criteria, limitations, billing and payment rules for outpatient psychological and neuropsychological testing for University Health Alliance members and providers.All University Health Alliance (HSA) updates
- Coverage CriteriaReimbursement/Payment PolicyEff. 2022-08-01Bio-Engineered Skin and Soft Tissue Substitutes ReimbursementThis UHA payment policy governs reimbursement coverage and medical necessity criteria for bio-engineered skin and soft tissue substitutes (including acellular dermal matrices, allografts, and specific commercial products) for procedures such as breast reconstruction, tendon repair, diabetic and venous lower-extremity ulcers, dystrophic epidermolysis bullosa, and certain burns. It affects UHA providers and members subject to benefit terms and administrative guidelines.All University Health Alliance (HSA) updates
- Coverage CriteriaReimbursement/Payment PolicyEff. 2022-08-01Cardiac Ablation Procedures — Reimbursement and Prior AuthorizationDefines UHA reimbursement, prior authorization, and medical necessity criteria for surgical and catheter cardiac ablation procedures for various arrhythmias; applies to University Health Alliance members and providers seeking payment.All University Health Alliance (HSA) updates
- Coverage CriteriaReimbursement/Payment PolicyEff. 2022-08-01Cellulitis and Chronic/Complex Wound Care Reimbursement PolicyDefines UHA reimbursement and medical necessity criteria for evaluation, management, and treatment of skin cellulitis, chronic and complex wounds (including related diagnostics, consultations, and place-of-service decisions) for University Health Alliance members.All University Health Alliance (HSA) updates
- Coverage CriteriaReimbursement/Payment PolicyEff. 2022-08-01Chronic Opioid Therapy (COT) reimbursement and monitoring for non‑cancer painDefines medical necessity criteria, documentation, and administrative rules for reimbursement of chronic opioid therapy for non-cancer pain under University Health Alliance (UHA). Affects providers prescribing long-term opioids to UHA members.All University Health Alliance (HSA) updates
- Coverage CriteriaReimbursement/Payment PolicyEff. 2022-08-01Durable Medical Equipment (DME) reimbursementThis policy governs reimbursement and coverage criteria for durable medical equipment, prosthetics, and orthotics for University Health Alliance members, including medical necessity, limitations, prior authorization, rental/purchase rules, and documentation requirements.All University Health Alliance (HSA) updates
- Coverage CriteriaClinical/Medical PolicyEff. 2022-08-01Eligibility for Dependents with Disabilities (Extended Dependent Coverage)Defines UHA coverage criteria, documentation, limitations, and administrative requirements for extending dependent coverage for members with disabilities under University Health Alliance plans.All University Health Alliance (HSA) updates
- Coverage CriteriaReimbursement/Payment PolicyEff. 2022-08-01Growth hormone (somatropin) therapy reimbursementDefines UHA reimbursement criteria, prior authorization requirements, limitations, monitoring, and continuation rules for growth hormone (somatropin) therapy for pediatric and adult indications.All University Health Alliance (HSA) updates
- Coverage CriteriaReimbursement/Payment PolicyEff. 2022-08-01Home Infusion Pain ManagementThis document governs reimbursement and medical necessity criteria for home infusion therapy for pain management provided to University Health Alliance members, including covered indications, limitations, prior authorization and administrative requirements.All University Health Alliance (HSA) updates
- Coverage CriteriaReimbursement/Payment PolicyEff. 2022-08-01Home Total Parenteral Nutrition (TPN) for AdultsDefines medical necessity, coverage criteria, limitations, and prior authorization/administrative requirements for reimbursement of home TPN (including IDPN) for adult members of University Health Alliance.All University Health Alliance (HSA) updates
- Coverage CriteriaReimbursement/Payment PolicyEff. 2022-08-01Kyphoplasty and Vertebroplasty Reimbursement PolicyDefines UHA reimbursement policy, medical necessity criteria, limitations, contraindications, and administrative prior authorization and documentation requirements for kyphoplasty and vertebroplasty for enrolled members and participating providers.All University Health Alliance (HSA) updates
- Coverage CriteriaReimbursement/Payment PolicyEff. 2022-08-01Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiotherapy (SBRT) ReimbursementThis payment policy governs University Health Alliance (UHA) reimbursement for SRS and SBRT when medically necessary and meeting specified clinical criteria, and describes limitations, exclusions, and administrative requirements (including prior authorization) for providers and members.All University Health Alliance (HSA) updates
- Coverage CriteriaReimbursement/Payment PolicyEff. 2022-08-01Treatment of hyperhidrosis (thoracic sympathectomy and related therapies)This payment policy governs reimbursement and medical necessity criteria for treatments of primary and secondary hyperhidrosis, including thoracic sympathectomy, and applies to providers and members covered by University Health Alliance (UHA).All University Health Alliance (HSA) updates
- Coverage CriteriaReimbursement/Payment PolicyEff. 2022-03-01Intensive Cardiac Rehabilitation (Dr. Dean Ornish Program) — Reimbursement and Medical NecessityThis policy governs UHA reimbursement and medical necessity criteria for intensive cardiac rehabilitation delivered through the Dr. Dean Ornish Program and applies to University Health Alliance members and participating providers.All University Health Alliance (HSA) updates
- Coverage CriteriaReimbursement/Payment PolicyEff. 2022-01-01Artificial insemination (IUI) reimbursementThis document governs University Health Alliance (UHA/HSA) reimbursement and coverage criteria for artificial insemination, including intrauterine insemination (IUI), and outlines clinical criteria, limitations, exclusions, and administrative requirements for members and providers.All University Health Alliance (HSA) updates
- Coverage CriteriaClinical/Medical PolicyEff. 2021-08-10Medical Necessity Determination (Coverage Criteria)Defines UHA's medical necessity criteria, decision-making process, applicable standards of evidence, and administrative guidelines for coverage determinations affecting health care services and products for UHA members.All University Health Alliance (HSA) updates
- Coverage CriteriaReimbursement/Payment PolicyEff. 2021-08-10Prophylactic (Risk‑Reducing) Mastectomy — Reimbursement/Payment PolicyDefines University Health Alliance reimbursement policy, coverage criteria, limitations, and administrative requirements (including prior authorization and applicable codes) for prophylactic (risk‑reducing) mastectomy for members and providers.All University Health Alliance (HSA) updates
- Coverage CriteriaReimbursement/Payment PolicyEff. 2021-06-15Cosmetic and Reconstructive Surgery ReimbursementGoverns reimbursement and coverage criteria for reconstructive and cosmetic surgery and related services for University Health Alliance members, including prior authorization requirements and exclusions.All University Health Alliance (HSA) updates
- Coverage CriteriaReimbursement/Payment PolicyEff. 2021-06-02Anesthesia Services for Gastrointestinal Endoscopic ProceduresDefines medical necessity criteria, limitations, and administrative rules for reimbursement of monitored anesthesia care, regional or general anesthesia for gastrointestinal endoscopic procedures for University Health Alliance members and contracted providers.All University Health Alliance (HSA) updates
- Coverage CriteriaReimbursement/Payment PolicyEff. 2021-06-02External Insulin Pump (E0784) Reimbursement PolicyDefines medical necessity, coverage criteria, limitations, and prior authorization requirements for reimbursement of external insulin pumps (E0784, A9274, S1034) for University Health Alliance members.All University Health Alliance (HSA) updates
- Coverage CriteriaReimbursement/Payment PolicyEff. 2021-06-02Inpatient Skilled Nursing Facility (SNF) reimbursementDefines medical necessity, coverage criteria, limitations, and payment-related administrative rules for inpatient SNF services offered to University Health Alliance members.All University Health Alliance (HSA) updates
- Coverage CriteriaReimbursement/Payment PolicyEff. 2021-06-02Panniculectomy and Abdominoplasty reimbursementThis policy governs UHA reimbursement for panniculectomy and abdominoplasty procedures when determined medically necessary and meeting specified clinical and administrative criteria; it applies to providers and members under University Health Alliance plans.All University Health Alliance (HSA) updates
- Coverage CriteriaReimbursement/Payment PolicyEff. 2021-06-02Varicose Veins Treatment Reimbursement and Prior-Authorization PolicyDefines UHA reimbursement and prior-authorization requirements for surgical and procedural treatment of primary venous insufficiency manifested by varicose veins, including coverage criteria, limitations, coding guidance, and administrative documentation requirements for providers and members.All University Health Alliance (HSA) updates
- Coverage CriteriaReimbursement/Payment PolicyEff. 2021-04-08Ambulatory Surgical Center (ASC) reimbursement criteriaDefines University Health Alliance (UHA) reimbursement policy for Ambulatory Surgical Center services, governing when ASC services are reimbursable and the administrative/medical necessity criteria providers must meet. Affects providers submitting ASC claims to UHA.All University Health Alliance (HSA) updates
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Tool Description
Search University Health Alliance (HSA) coverage criteria and medical necessity requirements across 21,000+ policies from 170+ payers.
Search a drug (“Wegovy”), a procedure (“knee replacement”), or a policy name, then filter by payer, specialty, policy type, or effective year. Or start from the largest publishers: UnitedHealthcare coverage criteria and Cigna coverage criteria.
Each result links the full policy page, which lists the clinical requirements, covered codes, and effective dates from the source document.
Pair a criteria search with the prior authorization lookup for approval requirements, the timely filing lookup for claim deadlines, the live policy updates feed for the newest payer publications, and payer profiles for contacts and coverage context.
FAQ
Coverage criteria are the specific clinical requirements a payer sets for covering a drug, procedure, or service: diagnoses, symptom duration, prior treatments tried, age limits, and documentation. They are published inside medical policies and clinical criteria documents, and a claim or authorization that does not meet them is denied as not medically necessary.
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