Month: July 2026
Modifier 25 Gets Slashed Again!
Is it October Already? Isn’t it to early for Horror stories?
I think you will find this one pretty chilling,
none the less.
Centers for Medicare and Medicaid Services (CMS) proposes to slash doctors’ payment when they bill an office/outpatient evalutation and management (E/M) service using modifier 25 on the same day as certain global procedures.
While being touted as a measure to reduce health care costs, Texas Medical Association President Bradford W. Holland, MD, warns the proposed change could create a perverse incentive under which patients who could have been treated in one visit end up having to be treated in two visits, a move he calls “unacceptable for patient care.”
Texas physicians routinely diagnose and treat patients in a single visit to avoid unnecessary care delays, and “if this modifier 25 policy is ultimately adopted, we are deeply concerned about the potential impact on patient access to timely care,” he said.
To Grasp the HORROR of it all,
Follow the Below links.
Angelina County Coverage and Benefits
It’s that time of year again.
Be mindful that a lot of plans have renewal dates in August.
CHECK ELIGIBILITY AND BENEFITS!
Angelina County Coverage Period August 1, 2026 – July 31, 2027
Medicare GLP-1 Bridge
Centers for Medicare & Medicaid Services (CMS)
Information for Prescribers
Superior, PCP Change Request Form
If you attended the Superior Meet and Greet in June, you may remember the discussion about helping our patients change their Primary Care Provider (PCP).
One of the links below provides a downloadable copy of Superior’s PCP Change Request Form, which was discussed during the meeting. You can use this form in your office whenever a member needs to change their PCP.
To save time, you may even want to pre-complete the top section for each PCP in your practice. Keep copies at the front desk so they are readily available, and simply make additional copies as needed.
Download the PCP form and keep it on hand for your staff.
UHC AARP Plans as of June/23/2026
YOU SHOULD ALWAYS CHECK NETWORK PARTICIPATION, DO NOT SKIP THIS STEP.
Please read this article closely. It could save you time, money, and headaches.
CMS assigns every Medicare Advantage organization a five-character contract number, sometimes called an H-code. That contract number represents the legal agreement between the insurance company and the federal government. A single insurer might hold several contract numbers. Not every contract number starts with “H.” CMS uses different letters for different plan types:
- H: Local plans, including most HMOs and local PPOs
- R: Regional PPO plans that cover a wider geographic area
- S: Stand-alone prescription drug plans (Part D only)
- E: Employer-sponsored Medicare Advantage and Part D plans
When comparing Medicare Advantage plan ID cards, it’s important to compare apples to apples.
However, the 5 digit contract number alone is not always enough. For example:
- AARP Medicare Advantage CareFlex from UHC-44 (HMO-POS) has contract number H0609.
- AARP Medicare Advantage Extras from UHC TX-27 (HMO-POS) also has contract number H0609.
Although these plans share the same contract number, they are different plans.
To accurately identify a member’s plan, compare the entire 11-character Plan ID, not just the H number. Using the full Plan ID helps ensure you are reviewing the correct plan and its associated benefits and network.
Please, Do Not Skip Verification
UHC disclaimer: Oxford Data refresh date: 06/16/2026, all other lines of business: 6/15/2026
To check your participation status with employer-specific plans, please contact your Advocate or Network Account Manager.
CONFIDENTIALITY NOTICE: Information accompanying this facsimile is considered to be UnitedHealthcare’s confidential and/or proprietary business
information. Consequently, this information may be used only by the person or entity to which it is addressed. Such recipient shall be liable for using and
protecting UnitedHealthcare’s information from further disclosure or misuse, consistent with applicable contract and/or law. The information you have received
may contain protected health information (PHI) and must be handled according to applicable state and federal laws, including, but not limited to HIPAA.
Individuals who misuse such information may be subject to both civil and criminal penalties. If you believe you received this information in error, please
contact the sender immediately.
If you would like this list in excel format, please contact POET office.
Remember these are Government Contracts and are subject to change.
Eligible Medicare beneficiaries may now get certain GLP-1 medications for $50.00
Eligible Medicare beneficiaries may now get certain GLP-1 medications for $50 per month through the Medicare GLP-1 Bridge, a new CMS initiative designed to expand access to innovative treatments and test the impacts of increased access to GLP-1 drugs for weight management on the Medicare program
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