Month: June 2026
Aetna, Changes to the National Precertification List
Changes to Aetna’s National Precertification List (NPL)
These updates apply to both our commercial and Medicare members, unless otherwise noted.
Effective July 1, 2026, we’ll remove stimulated intrauterine insemination (iui), case rate (S4035).
Effective July 1, 2026, we’ll remove precertification for the following drug: Tegsedi® (inotersen) (J3490, J3590, C9399)
Superior Providers Have You RSVPed?
Join Us This Friday at the Affinity Center
If you have not RSVP’ed, please do.
This is your chance to visit face to face with Superior personnel.
Must be a Superior Provider through the POET Contract.
The POET office will be closed Friday from 10:15 a.m. to 2:00 p.m.
as staff prepare for and attend the Superior Meet & Greet.
If an urgent matter arises during this time, please call the POET Office.
MultiPlan Provider Litigation
Federal Antitrust Litigation Seeks to Hold MultiPlan, Major Insurance Companies Responsible for Alleged Coordinated Price-Fixing Scheme
Leading to Under-Reimbursement for Out-of-Network Services
The Texas Medical Association (TMA) has joined a federal multidistrict litigation against MultiPlan (recently rebranded to Claritev) and major insurers, including UnitedHealth, Elevance, Humana, Aetna, and Cigna, alleging they conspired to systematically underpay health care practitioners for reimbursements for out-of-network services, which often fail to even cover operating costs. MultiPlan goes by many names, including Data iSight, Viant, NCN, ProPricer, and MARS. Plaintiffs allege that MultiPlan facilitated a price-fixing agreement among insurers that artificially suppressed out-of-network payment rates and cost physicians and providers billions of dollars.
TMA joins the American Medical Association (AMA) and hundreds of physician practices and facilities nationwide in this growing antitrust litigation.
“For many years, physicians in Texas have been forced to accept increasingly insufficient reimbursements for providing health care to out-of-network patients,” said TMA President Jayesh “Jay” Shah, MD. “This lawsuit is an important step to ensure that physicians are justly reimbursed for the care they provide, not only today, but also for historical underpayments going back to at least 2015, and end this alleged illegal collusion that hurts patients.”
This lawsuit, filed in the Northern District Court of Illinois in 2024, seeks to end MultiPlan’s alleged anticompetitive scheme that it has operated since at least 2015, and recoup financial damages for practitioners and practices. As of 2024, MultiPlan processes more than 80% of all commercial out-of-network reimbursement claims in the United States. Physicians and providers may not always know whether MultiPlan, or one of its services like Data iSight, Viant, NCN, ProPricer, or MARS, re-priced their claims. Clues can often be found in Explanations of Benefits or remittance advice.
Physicians who believe they have been harmed by MultiPlan and the insurance companies, whether current or in past years, can obtain a free case evaluation from one of the attorneys appointed by the court to lead the non-class claims.
The court also has appointed attorneys to litigate a proposed antitrust class action on the same issues, but a ruling on any proposed class certification is not expected until 2027. Physicians and providers who believe they have been impacted by MultiPlan’s conduct can choose to pursue their claims individually on a non-class basis and do not need to wait for any ruling on a proposed class.
Complete Your Medicaid Revalidation to Avoid Disenrollment
Texas physicians with Medicaid revalidation applications currently being processed, with deadlines on or before May 31, will be granted extensions ranging from 60 to 180 days, per the Texas Medicaid & Healthcare Partnership (TMHP).
TMHP offers the following online guidance:
- A physician who has not received a previous extension, and has a revalidation due date on or before May 31 is eligible for a first-time revalidation extension of 180 calendar days once the application is submitted (which TMHP labels “in-flight”); and
- A physician with an in-flight revalidation application already submitted and a due date on or before May 31, is eligible for a second extension of 180 days and a third extension of 60 days, plus additional 60-day extensions beyond the third.
The Texas Medical Association advises applicants who haven’t started revalidation yet to check due dates in the Provider Enrollment and Management System (PEMS), and especially if the due date is within 180 days, to fill and send their application promptly.
Also, physicians should note that a draft of an application saved in PEMS is not considered in-flight; it must be completed and submitted to gain in-flight status and thus the second and third extensions. Revalidation is not complete until an applicant’s revalidation request shows it is in “closed-enrolled” status.
Any extensions granted will be reflected in the “revalidation due dates” column on the Provider Information page of PEMS, TMHP says.
Physicians will also receive an email notification confirming their new revalidation due date once an extension is issued.
TMHP grants 165 cumulative business days to address all deficiencies on a revalidation application. If the revalidation application has unresolved issues taking it beyond that window, TMHP will close the application, requiring the physician to submit a new revalidation request.
Through its Physician Payment Resource Center, TMA offers help to physicians unfamiliar with the process or who have specific questions about using PEMS.
Last Updated On:
June 08, 2026
Originally Published On:
April 23, 2026
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