Category: Business

2nd Regulation Released Implementing No Surprises Act

 Author: Seymore Bones  Published Date: October 12, 2021  Leave a Comment on 2nd Regulation Released Implementing No Surprises Act

On Thursday, Sept. 30, the Office of Personnel Management and the Departments of Health and Human Services, Labor, and Treasury, released the second regulation implementing provisions of the No Surprises Act. On Dec. 27, 2020, the No Surprises Act was signed into law with the goal of protecting patients from receiving surprise medical bills. This rule follows prior rulemaking outlining patient protections against surprise medical bills, establishing out-of-pocket limits, and notice and consent requirements.

This rule implements dispute resolution processes for providers, patients, and health plans and takes effect Jan. 1, 2022. Consistent with the intent of the law and previous rules from the Administration, patients continue to remain harmless from outstanding surprise medical bills.

Follow these links for more information from CMS.gov.

Requirements Related to Surprise Billing; Part II Interim Final Rule with Comment Period
What You Need to Know about the Biden-Harris Administration’s Actions to Prevent Surprise Billing (September 2021)
MGMA

AMA announces CPT® code ready for third dose of Moderna COVID-19 vaccine.

 Author: Seymore Bones  Published Date: October 8, 2021  Leave a Comment on AMA announces CPT® code ready for third dose of Moderna COVID-19 vaccine.
Link to CPT News Alert

CignaforHCP Training on Newest Features.

 Author: Seymore Bones  Published Date: October 8, 2021  Leave a Comment on CignaforHCP Training on Newest Features.

Online Appeals and Claim Reconsideration and Procedure Code Lookup, 

Interactive Staff Training. 

SIGN UP HERE !!

UHC No Longer Sending PRAs by Mail

 Author: Seymore Bones  Published Date: October 6, 2021  Leave a Comment on 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.

To view the full article and instructions, follow this link.

HealthSelect ERS

 Author: Seymore Bones  Published Date: October 6, 2021  Leave a Comment on 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 PDF Document. BCBSTX is currently working on system updates to reflect this change.

Remember to use Availity®Learn more about third-party links 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.

BCBS Update

Flu Season Is Here

 Author: Seymore Bones  Published Date: October 5, 2021  Leave a Comment on Flu Season Is Here
Click to see the latest updates from CMS

UHC Network News Brief 10/1/2021

 Author: Seymore Bones  Published Date: October 5, 2021  Leave a Comment on 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

 

Click here to view the full article in your browser
Click here to review the full Network Bulletin, October 2021 Edition

News for BCBS Employer Groups

 Author: Seymore Bones  Published Date: September 28, 2021  Leave a Comment on News for BCBS Employer Groups

Sept. 24, 2021 | BCBSTX News

Update to 2022 Telehealth Services

In support of our members and employer groups, in 2022 we will continue to cover the expanded telehealth services that we’ve covered this year. This is our standard coverage.

Federal Government Releases Proposed Rule Related to Surprise Billing, Transparency

The proposed rule provides new regulations to implement sections of Consolidated Appropriations Act of 2021. Topics covered include air ambulance reporting, agent and broker compensation disclosure and reporting, and enforcement of No Surprises Act requirements

Click here to view the full article

Vaccine Documentation Can’t be Required for Medical Treatment

 Author: Seymore Bones  Published Date: September 27, 2021  Leave a Comment on Vaccine Documentation Can’t be Required for Medical Treatment

The Texas Health and Human Services Commission (HHSC) is notifying practitioners who see Medicaid patients that those patients can’t be required to provide documentation of their COVID-19 vaccination status as a condition of receiving services under Texas Medicaid.

The agency’s Sept. 17 announcement references Gov. Greg Abbott’s Aug. 25 executive order, which bars “[a]ny public or private entity that is receiving or will receive public funds through any means” from requiring COVID-19 vaccination documentation to receive services.

Click here to review the full article at texmed.org

KNOW YOUR TRS

 Author: Seymore Bones  Published Date: September 15, 2021  Leave a Comment on KNOW YOUR TRS

This Information Pertains to POET Contracts ONLY!

Blue Choice PPO, Blue Essentials HMO, or UHC MA?

TRS Plan Name: 

TRS-Care Medicare Advantage

TRS-Care Standard

TRS-ActiveCare Primary

TRS-ActiveCare Primary Plus

TRS-ActiveCare HD

TRS-ActiveCare 2

Scott and White Health Plan

South Texas HMO

West Texas HMO

POET Agreement:

UHC All Products

Blue Choice PPO

Blue Essentials HMO

Blue Essentials HMO

Blue Choice PPO

Blue Choice PPO

NO

Blue Essentials HMO

Blue Essentials HMO

Alpha Prefix or Plan:

80840

T3X

T2U

T2U

T2S

T2S

U/N

U/N

U/N

Plan Year:

2021

2021

9/1/2021-8/31/2022

9/1/2021-8/31/2022

9/1/2021-8/31/2022

9/1/2021-8/31/2022

9/1/2021-8/31/2022

9/1/2021-8/31/2022

9/1/2021-8/31/2022

You will probably not see the last 3 in italics. They are regional and not offered locally. 

Know Your TRS