Category: Business
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.
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.
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
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