Month: October 2021
CignaforHCP Training on Newest Features.
Online Appeals and Claim Reconsideration and Procedure Code Lookup,
Interactive Staff Training.
OOPS!! Cigna MA Letter ERROR
Apparently a letter went out to some Cigna members that was supposed to be alerting them that the contract with the CHS hospital (WHMC) is being terminated. There was an error in the letter because it stated “Your doctor is leaving the network”. This has caused a flurry of concern and confusion in some areas, as you might imagine. A corrected letter, further clarifying that the entity being terminated is the hospital and not the physician, is expected to go out Oct. 5th.
UHC No Longer Sending PRAs by Mail
PRAs (Provider Remittance Advice) will go paperless by region starting Nov. 12.
Please review this map for effective dates and exclusions by geographical region.
HealthSelect ERS
Effective Sept. 1, 2021, HMO plans will no longer be an enrollment option under the Texas Group Benefit Program. All current subscribers and dependents enrolled in one of the HMO plans will be automatically enrolled in HealthSelect of Texas administered by Blue Cross and Blue Shield of Texas, unless they elect otherwise during their summer enrollment period
Participants who are transitioning from an HMO plan will have a 90-day referral grace period and will receive in-network benefits if they see an in-network specialist without a referral during this timeframe. After Nov. 30, 2021, if there is not a referral on file with BCBSTX, the specialist visit will be covered at the out-of-network benefit level, even if the specialist is in-network.
Effective Sept. 1, 2021, certain procedure codes are being removed from the list of services that require prior authorization for HealthSelect of Texas® & Consumer Directed HealthSelectSM participants. You can review a list of the codes being removed here 
. BCBSTX is currently working on system updates to reflect this change.
Remember to use Availity®
or your preferred vendor to check eligibility and benefits before rendering services. This will help you confirm coverage details and prior authorization requirements and determine if you are in-network for the member’s policy. Refer to Eligibility and Benefits for details.
UHC Network News Brief 10/1/2021
Catch All the UHC UPDATES
October 2021 Policy and Protocol Updated Overview
- Medical policy update: October 2021
- Pharmacy Updates
- Prior Authorization and Notification Requirement Updates and 2021 Summary of Changes
- Reimbursement Policy Updates: October 2021
- Specialty Medical Injectable Drug Program Updates: October 2021
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