Month: September 2021

News for BCBS Employer Groups

 Author: Seymore Bones  Published Date: September 28, 2021  Leave a Comment on News for BCBS Employer Groups

Sept. 24, 2021 | BCBSTX News

Update to 2022 Telehealth Services

In support of our members and employer groups, in 2022 we will continue to cover the expanded telehealth services that we’ve covered this year. This is our standard coverage.

Federal Government Releases Proposed Rule Related to Surprise Billing, Transparency

The proposed rule provides new regulations to implement sections of Consolidated Appropriations Act of 2021. Topics covered include air ambulance reporting, agent and broker compensation disclosure and reporting, and enforcement of No Surprises Act requirements

Click here to view the full article

Vaccine Documentation Can’t be Required for Medical Treatment

 Author: Seymore Bones  Published Date: September 27, 2021  Leave a Comment on Vaccine Documentation Can’t be Required for Medical Treatment

The Texas Health and Human Services Commission (HHSC) is notifying practitioners who see Medicaid patients that those patients can’t be required to provide documentation of their COVID-19 vaccination status as a condition of receiving services under Texas Medicaid.

The agency’s Sept. 17 announcement references Gov. Greg Abbott’s Aug. 25 executive order, which bars “[a]ny public or private entity that is receiving or will receive public funds through any means” from requiring COVID-19 vaccination documentation to receive services.

Click here to review the full article at texmed.org

Physician Directory Update

 Author: Seymore Bones  Published Date: September 23, 2021  Leave a Comment on Physician Directory Update

Who needs Google Maps, when you can download the Physician Directory from the POET INK files?

Click here

To download your front desk copy, just click.

You are welcome to Print this for your front desk.

UHC New EDI Edits for MA Claims

 Author: Seymore Bones  Published Date: September 21, 2021  Leave a Comment on UHC New EDI Edits for MA Claims

EDI claim edits now notify you of missing or mismatched information.

As of Aug. 28, 2021, the new payer-level edits for Electronic Data Interchange (EDI) 837 claim submissions provide alerts of specific information that may be missing or doesn’t match data contained in our systems.

How will you be notified of claim issues?

Claims that are rejected for these edits will appear on your claims rejection report, also known as a 277CA report. UHC is no longer mailing letters about claim submissions that need attention. Instead, your clearinghouse will be responsible for notifying you of any issues.

What do you need to do?

Ensure you are receiving these messages from your clearinghouse. Claims that are rejected should be corrected and resubmitted electronically to be accepted into our processing system for adjudication. 

View 277CA Edits
For additional Information

KNOW YOUR TRS

 Author: Seymore Bones  Published Date: September 15, 2021  Leave a Comment on KNOW YOUR TRS

This Information Pertains to POET Contracts ONLY!

Blue Choice PPO, Blue Essentials HMO, or UHC MA?

TRS Plan Name: 

TRS-Care Medicare Advantage

TRS-Care Standard

TRS-ActiveCare Primary

TRS-ActiveCare Primary Plus

TRS-ActiveCare HD

TRS-ActiveCare 2

Scott and White Health Plan

South Texas HMO

West Texas HMO

POET Agreement:

UHC All Products

Blue Choice PPO

Blue Essentials HMO

Blue Essentials HMO

Blue Choice PPO

Blue Choice PPO

NO

Blue Essentials HMO

Blue Essentials HMO

Alpha Prefix or Plan:

80840

T3X

T2U

T2U

T2S

T2S

U/N

U/N

U/N

Plan Year:

2021

2021

9/1/2021-8/31/2022

9/1/2021-8/31/2022

9/1/2021-8/31/2022

9/1/2021-8/31/2022

9/1/2021-8/31/2022

9/1/2021-8/31/2022

9/1/2021-8/31/2022

You will probably not see the last 3 in italics. They are regional and not offered locally. 

Know Your TRS

Important Cigna CoVid Updates

 Author: Seymore Bones  Published Date: September 9, 2021  Leave a Comment on Important Cigna CoVid Updates
To View the Update Click
Since the COVID-19 pandemic began, Cigna has taken important steps to deliver accommodations to providers and customers, helping to ensure that our customers have continued access to COVID-19 screening, testing, treatment, and vaccinations in safe settings.
Please click on the button to view this update.

Seasonal Influenza Vaccine Pricing

 Author: Seymore Bones  Published Date: September 8, 2021  Leave a Comment on Seasonal Influenza Vaccine Pricing

As posted by CMS.gov.

For Full Details

CMS Web-Based Learning

 Author: Seymore Bones  Published Date: September 7, 2021  Leave a Comment on CMS Web-Based Learning

Have you and your staff completed your Annual Fraud, Waste and Abuse (FWA) training for 2021 as outlined in the 2021 Medicare Compliance Program Guidelines Attestation for Downstream Entities?

  1. Fraud, Waste and Abuse (“FWA”) Training

Fraud, Waste and Abuse Training was provided in 2021 to all of our employees, contractors and downstream entities who are assigned to work on Medicare business.  This occurred initially during the orientation period and annually thereafter.  Records of Fraud, Waste and Abuse Training completion are maintained for at least 10 years

 

CMS has recently revised their Multimedia Web-based Training. 

And it’s free

Check it out

POET Closure

 Author: Seymore Bones  Published Date: September 6, 2021  Leave a Comment on POET Closure

POET will be closed today in honor of Labor day.

Your Notice of Protocol and Policy Changes from UHC

 Author: Seymore Bones  Published Date: September 3, 2021  Leave a Comment on Your Notice of Protocol and Policy Changes from UHC
  • Medical Policy Updates Effective 9/1
  • Prior Authorization and Notification Requirement Changes
  • Reimbursement Policy Updates
  • And More
Follow this link for the September Bulletin Overview.