Category: Business
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.
CIOX What Are Your Options
Did you say Cyclops?
Or was that Sick Ox?
No, Silly. CIOX
Medical records can be submitted through the following options:
1. PROVIDER PORTAL:
Upload the medical records to Ciox’s secure
provider portal at https://www.cioxlink.com
using the following credentials:
Username: C34765843
Password: eeE4^fe8
2. REMOTE EMR Retrieval:
Set up secure remote connection from a
provider site’s EMR directly to Ciox for timely
off-site remote retrieval of records with
trained associates at Ciox by
contacting 1-877-445-9293
3. ONSITE Chart Retrieval:
Schedule on-site retrieval with a complimentary Ciox
Chart Retrieval Specialist or review any aspects of the on-site retrieval services at Ciox by
contacting 1-877-445-9293
4.FAX:
Send secure faxes to 1-972-957-2216
5. MAIL:
Mark “Confidential” on the envelope and mail the medical records to: CIOX Health
2222 W. Dunlap Ave. Phoenix, AZ 85021
Humana Physician News Q1 2023
Just to mention a few topics:
- Financial Assistance for patients
- Real-time Benefit check
- Medication reconciliation for reduced hospital readmission
UHC Reconsideration and Appeals Going Digital
This change affects Commercial and MA health care professionals.
UHC Network News
Billing Codes Reported to Payor May Differ from Codes Authorized.
Have you ever requested authorization on a particular procedure (CPT Code) only to find out afterward there are additional codes or even a totally different CPT code than you requested?
It doesn’t help that only some payors allow for a retro authorization (auth)
and usually they have a short turnaround time.
Below are some tips from the MGMA Community.
From a Surgical Practice:
- Have the Surgical attendee to inform the Prior Auth. Manager or Coder as soon as the procedure is completed.
- The coder should compare procedure notes to the auth prior to billing.
From an ENT Practice:
- Have the physician give you all the possible CPT codes that could be performed and precert. them to be on the safe side.
From a Gastro Practice:
- Again request an auth. for all possible code combinations from the payor.
From an Ortho:
- Create a report that compares billed codes to approved codes.
- Then hold the claim for business days to make certain you have time to reach out to insurers and make adjustments.
- They have found that most insurers want it updated before they process the claim. Which is what the office wants also because it prevents refiling. Even if it takes additional months to get the prior auth. changed.
Summarized:
- Authorize all possible codes for the procedure.
Work with your insurance follow up team to identify our opportunities. This may lead to updates on how you order certain procedures. An update to both system and workflow.
- Timely charge capture. Because retro auth windows are short for some payors, it is imperative to understand if the codes being captured is different from codes authorized.
Same as #1. You have to assess how the charge lag is contributing to the denials.
- A process to compare codes being captured vs authorized and request retro auth.
This concept is for review before charges are submitted. Compare codes in charge sessions vs the codes authorized and flag sessions that have discrepancies so retro auth can be pursued.
Have You Downloaded 2023 Provider Roster?
This is a great tool for the person in your office that has the responsibility of referrals.
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