Month: August 2021
Aetna OfficeLink Updates 9/1/2021
Aetna is going paperless. Here is how to get your electronic EOB Statements and Payments.
Starting in September through 2022, we’re phasing out paper Explanation of Benefits (EOB) statements and checks. Sign up before it’s your turn. If you don’t enroll to receive direct deposit payments, you may receive future payments by virtual credit card. Keep reading to learn more.
Get EOB statements from Availity®
Register for our provider portal on Availity. Get identical copies of your EOB statements from the Availity Remittance Viewer. Then print or save them to your computer. You won’t need to wait for them to arrive in the mail.
Sign up for direct deposit payments
Sign up for direct deposit payments using our new portal, Payer Enrollment Services. Just goto Payer Enroll Services. We’ll stop using EnrollHub® effective September 1. Even if you’re
already enrolled to receive direct deposit payments (or electronic remittance advice), use the new portal to make changes.
Visit AetnaPaperlessOffice to learn more about your options
Third Party Claim and Code Review Program
Beginning December 1, 2021, you may see new claim edits. These are part of our Third Party Claim and Code Review Program. These edits support our continuing effort to process claims accurately for our commercial and Medicare members. You can view these edits on our provider portal.
We may request medical records for certain claims, such as high-dollar claims, implant claims and bundled-services claims, to help confirm coding accuracy.
You’ll have access to our prospective claims editing disclosure tool. To find out if our new claim edits will apply to your claim, log in to the Availity provider portal. Once there, go to Aetna’s Payer Space > Applications > Code Edit Lookup Tools. You’ll need to know your Aetna® provider ID number (PIN) to use the tools.
For all coding changes, go to Aetna Payer Space > Resources > Expanded Claim Edits
Provider Star Training
And CMEs to Boot
Cigna Medicare Advantage has two new on-demand webcast available for Stars.
Both of these web-cast have CME credits attached to them.
Check them out, by clicking on their individual button.
HIPAA: Back to Basics with the BAA
With cybersecurity and criminal government actions involving protected health information (PHI), now is a good time to understand the importance of the required Business Associate Agreement (BAA).
HIPAA: Back to basics with the BAA
Defined: “business associate” is a person or entity, other than a member of the workforce of a covered entity, who performs functions or activities on behalf of, or provides certain services to, a covered entity that involve access by the business associate to protected health information. A “business associate” also is a subcontractor that creates, receives, maintains, or transmits protected health information on behalf of another business associate. (emphasis added).
Business Associates encompasses a wide range of persons, which include, but are not limited to: accountants, attorneys, private equity firms, technology companies, app developers, independent contractors, medical device companies, and pharmaceutical companies. Bottom line—if you or your company “creates, receives, maintains, or transmits” protected health information in an electronic form, a BAA is required. This is not new—the requirement existed long before the HIPAA Final Omnibus Rule was published in the Federal Register on January 25, 2013.
HIPAA compliance is not optional and depending on the facts and circumstances, may lead to significant civil and/or criminal liability.
HIPAA, like the Federal Anti-Kickback Statute (AKS), has criminal penalties available to HHS. The DOJ is responsible for criminal prosecutions, as HHS states on its website.
TMA “Ask the Expert” Virtual Series
Today’s “Ask the Expert” subject “How to Delegate to Non-physician Practioners” will be available On-Demand in a couple weeks. The link to access the recording will be www.texmed.org/asktheexpert.
UPCOMING TOPICS
VENDOR POLL
Please help POET, help your office.
Please take a moment to respond (comment) to the below questions.
- What vendor are you using for after hour calls?
- Does that vendor triage?
Prior Auth Changes, Superior
Prior Authorization Changes,
Effective September 1, 2021
New Codes Requiring Auths:
- 33270
- 33271
- 33274
Prior Auths Removed:
- 33273
- 93287
- 93290
TX Prescription Monitoring Program
TX Prescription Monitoring Program, No Longer a Freebie!!
When Texas started requiring that physicians check the state’s prescription monitoring program (PMP), the state appropriated funds to cover the licensing fee for the first two years. Effective Sept. 1, however, that fee is no longer covered by the state, and Appriss, the state’s PMP vendor, has begun billing physicians for the annual PMP licensing fee.
TMA is exploring options with the governor’s office, Texas State Board of Pharmacy, and Appriss to tap into the opioid settlement funds to defray the cost of the PMP. However, it does not appear that funding will be available prior to Sept. 1, TMA officials say.
The association has reached out to Appriss to understand the pricing structure on the invoice that physicians are receiving. Appriss has indicated the following options for physicians:
- Cost for the basic service – integrated access to the PMP through the physician’s electronic health record– is $50 per prescriber per year. This is access to controlled substance prescription data only.
- Cost for the optional NarxCare graphic interface and Appriss analytics is an additional $250 per prescriber per year.
- Always available at no cost is manual web access to the PMP through the Texas Board of Pharmacy via PMP Aware.
Physician groups may check with Appriss to see if they are eligible for reduced pricing per prescriber.
At TMA’s urging, Appriss is working on additional communications to physicians that more clearly explain the options and associated fees.
If you choose not to renew with Appriss, access to the PMP will no longer be accessible through your EHR within your workflow. It will still be available for free when you log in to the state’s system, PMP Aware, to check a patient’s prescribing history as required by law before prescribing opioids, benzodiazepines, barbiturates, and carisoprodol.
Questions about prescribing and the PMP program may be directed to TMA’s Health Information Technology Department by calling (800) 880-5720 or by email. Also check out TMA’s PMP resource page.
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