Month: March 2023
CHIP Co-Pay Resumes
At the end of the PHE, May 11, 2023
Superior announcing the CHIP Co-Pay will resume.
More on UHC Electronic Submissions
Get to know the basics of electronic submissions
Now that claim reconsiderations and appeals must be submitted electronically,* we want to help make sure you have the how-to information you need to manage them with ease.
How to submit electronically
You have 2 electronic submission options — through the UnitedHealthcare Provider Portal or Application Programming Interface (API). See the Online Reconsiderations and Appeals interactive guide for step-by-step instructions on how to submit reconsiderations and appeals electronically.
TIPS:
- Check the TrackIt Action Required bar regularly to see the status of claims, reconsideration requests and more
- To take action on a specific claim in the portal, go to Claims & Payments and search for a claim. Once you’ve searched for a claim and selected Act on a Claim, a list of actions will appear (e.g., View Claim Reconsideration, File Appeal/Dispute). Based upon the current status of the claim or previously taken actions, the buttons will either be blue or grayed out. If grayed out, that specific action is unavailable.
- Please note: Available actions may vary based on the member’s plan type, provider’s participation status and regulations
- If a claim(s) from your claim search results shows an “Acknowledgement” status, it hasn’t been processed. You’ll be unable to submit requests related to this claim.
- Reminder: Appeal response letters are no longer mailed, but you can view and print them through the portal using Document Library
ASK THE EXPERT
TMA RESOURCES |
Ask the Expert: End of the Public Health EmergencyOn March 29 via Zoom, join TMA experts in this interactive Q&A session as they discuss how best to prepare your practice for upcoming changes as the public health emergency winds down on May 11. They will discuss the impact on Medicaid coverage, telehealth, and COVID vaccines and treatments for which you can earn CME. Send your questions in advance. Register now. |
Superior Risk Adjustment Training
Superior will be hosting a series of webinars to assist providers with Risk Adjustment Documentation and Coding. All levels of clinicians and billing and coding staff are encouraged to attend.
Health Plan – Representative Update
Please print this updated list. Keep it handy for working claim issues. Many have changed.
HHS Announces End of PHE
According to HHS.Gov Fact Sheet: COVID-19 Public Health Emergency Transition Road Map
The Public Health Emergency (PHE) for COVID-19 is scheduled to expire at the end of the day on May 22, 2023.
Just in Aetna OfficeLink Update
Changes to Aetna’s Commercial drug list BEGIN ON JULY 1st
“On July 1, 2023, we’ll update our pharmacy drug lists. Changes may affect all drug lists, precertification, step therapy and quantity limit programs.
You’ll be able to view the changes as early as May 1. They’ll be on our Formularies and Pharmacy Clinical Policy Bulletins page.”
Ways to request a drug prior authorization:
- Submit your completed request form through our Availity provider portal.*
- For requests for non-specialty drugs, call 1-800-294-5979 (TTY: 711). Or fax your authorization request form (PDF) to 1-888-836-0730.
- For requests for drugs on the Aetna Specialty Drug List, call 1-866-814-5506 or go to our Forms for Health Care Professionals page and scroll down to the Specialty Pharmacy Precertification (Commercial) drop-down menu. If the specific form you need is not there, scroll to the end of the list and use the generic Specialty Medication Precertification request form. Once you fill out the relevant form, fax it to 1-866-249-6155.
For more information, call the Provider Help Line at 1-800-AETNA RX (1-800-238-6279) (TTY: 711).
UHC March Overview is Here.
UHC Network News is published twice a month.
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