Category: Business
Important Cigna CoVid Updates
Since the COVID-19 pandemic began, Cigna has taken important steps to deliver accommodations to providers and customers, helping to ensure that our customers have continued access to COVID-19 screening, testing, treatment, and vaccinations in safe settings. Please click on the button to view this update. |
POET Closure
POET will be closed today in honor of Labor day.
Your Notice of Protocol and Policy Changes from UHC
- Medical Policy Updates Effective 9/1
- Prior Authorization and Notification Requirement Changes
- Reimbursement Policy Updates
- And More
Humana’s Covid-19 Response
An important message regarding
Humana’s COVID-19 response:
ADMINISTRATIVE UPDATE Sept. 1, 2021
Humana is suspending authorization requirements for skilled nursing facilities (SNFs) and
long-term acute care (LTAC) for Medicare Advantage and commercial members discharging
from hospitals in the state of Texas through Oct. 1, 2021.
Important details:
- Authorization suspension, as outlined herein, will continue through Oct. 1, 2021.
- This suspension applies to participating/in-network providers only.
- Please provide notification of admission within 24 hours to allow us to track our members’ progress. You will receive
an approval when you submit the notification. - No other services requiring prior authorization are included in this suspension.
Aetna OfficeLink Updates 9/1/2021
Aetna is going paperless. Here is how to get your electronic EOB Statements and Payments.
Starting in September through 2022, we’re phasing out paper Explanation of Benefits (EOB) statements and checks. Sign up before it’s your turn. If you don’t enroll to receive direct deposit payments, you may receive future payments by virtual credit card. Keep reading to learn more.
Get EOB statements from Availity®
Register for our provider portal on Availity. Get identical copies of your EOB statements from the Availity Remittance Viewer. Then print or save them to your computer. You won’t need to wait for them to arrive in the mail.
Sign up for direct deposit payments
Sign up for direct deposit payments using our new portal, Payer Enrollment Services. Just goto Payer Enroll Services. We’ll stop using EnrollHub® effective September 1. Even if you’re
already enrolled to receive direct deposit payments (or electronic remittance advice), use the new portal to make changes.
Visit AetnaPaperlessOffice to learn more about your options
Third Party Claim and Code Review Program
Beginning December 1, 2021, you may see new claim edits. These are part of our Third Party Claim and Code Review Program. These edits support our continuing effort to process claims accurately for our commercial and Medicare members. You can view these edits on our provider portal.
We may request medical records for certain claims, such as high-dollar claims, implant claims and bundled-services claims, to help confirm coding accuracy.
You’ll have access to our prospective claims editing disclosure tool. To find out if our new claim edits will apply to your claim, log in to the Availity provider portal. Once there, go to Aetna’s Payer Space > Applications > Code Edit Lookup Tools. You’ll need to know your Aetna® provider ID number (PIN) to use the tools.
For all coding changes, go to Aetna Payer Space > Resources > Expanded Claim Edits
HIPAA: Back to Basics with the BAA
With cybersecurity and criminal government actions involving protected health information (PHI), now is a good time to understand the importance of the required Business Associate Agreement (BAA).
HIPAA: Back to basics with the BAA
Defined: “business associate” is a person or entity, other than a member of the workforce of a covered entity, who performs functions or activities on behalf of, or provides certain services to, a covered entity that involve access by the business associate to protected health information. A “business associate” also is a subcontractor that creates, receives, maintains, or transmits protected health information on behalf of another business associate. (emphasis added).
Business Associates encompasses a wide range of persons, which include, but are not limited to: accountants, attorneys, private equity firms, technology companies, app developers, independent contractors, medical device companies, and pharmaceutical companies. Bottom line—if you or your company “creates, receives, maintains, or transmits” protected health information in an electronic form, a BAA is required. This is not new—the requirement existed long before the HIPAA Final Omnibus Rule was published in the Federal Register on January 25, 2013.
HIPAA compliance is not optional and depending on the facts and circumstances, may lead to significant civil and/or criminal liability.
HIPAA, like the Federal Anti-Kickback Statute (AKS), has criminal penalties available to HHS. The DOJ is responsible for criminal prosecutions, as HHS states on its website.
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