Category: Medicare
POET Is Seeing a Trend
Please contact POET if you are experiencing a similar problem. (936) 637-7638
POET has received a few calls this week from Specialists (SCP) stating that Primary Care Physicians (PCP) have not been able to get the SCP a referral. The PCP office is stating Cigna MA is showing the SCP out of network.
- POET has been in contact with Cigna MA regarding the situation. Cigna will be reviewing to see if there is a greater problem.
- So far it appears to only be effecting SCPs in the HMO product.
- Just a reminder: SCPs do not need a referral due to the Public Health Emergency (PHE). The PHE is scheduled to lapse on January 16, 2022. POET has been on the Public Health Emergency website and the U.S. Department of Health & Human Services website to look for new information on the PHE lapse date. We have nothing to report as of this post.
Medicare FFS Claims: 2% Payment Adjustment (Sequestration) Changes
- No payment adjustment through March 31, 2022
- 1% payment adjustment April 1 – June 30, 2022
- 2% payment adjustment beginning July 1, 2022
MGMA Legislative Alert
POSTED 12/9/2021 6:51 PM
Humana Physician News-Q4 Edition
Effective Dec. 31, 2021, the Provider Payment Integrity (PPI) contact mailbox will be disabled.
To manage overpayments, please use the Availity Portal or call Customer Care at 800-438-7885, Monday – Friday, 8 a.m. – 8 p.m., Eastern time.
Looking for new ways to reach and engage your patients?
Humana has developed the Provider Marketing Resource Center (PMRC) so you can engage, retain and grow your practice’s patient panel, regardless of their current insurance carrier.
Contact [email protected] for access to their library of customizable patient marketing materials.
UHC New EDI Edits for MA Claims
EDI claim edits now notify you of missing or mismatched information.
As of Aug. 28, 2021, the new payer-level edits for Electronic Data Interchange (EDI) 837 claim submissions provide alerts of specific information that may be missing or doesn’t match data contained in our systems.
How will you be notified of claim issues?
Claims that are rejected for these edits will appear on your claims rejection report, also known as a 277CA report. UHC is no longer mailing letters about claim submissions that need attention. Instead, your clearinghouse will be responsible for notifying you of any issues.
What do you need to do?
Ensure you are receiving these messages from your clearinghouse. Claims that are rejected should be corrected and resubmitted electronically to be accepted into our processing system for adjudication.
In Accurate Medicare Claim DENIALS!!
Novitas Solutions, the Medicare payer for Texas, announced that a system error has caused the improper rejection of Medicare Part B claims submitted on or after July 6. Physicians who received a claim rejection message should not resubmit claims at this time. Novitas says it is researching a claims processing system fix. TMA is monitoring the problem.
HealthSpring Insurance Card
You may have noticed the Cigna MA (HMO) insurance card no longer sports the “HealthSpring” name.
Here is a tip.
There are only three customer benefit plans (HMO) for our service area.
- 2021-TX-H4513-061-Preferred (HMO) – Medicare A, B, & D coverage
- 2021-TX-H4513-060-TotalCare (HMO DSNP) – Medicare/Medicaid A, B, & D coverage
- 2021-TX-H4513-009-Fundamental (HMO) – Medicare A & B coverage only (no part D); formerly known as the Advantage plan
Where you see “contract/PBP” with the orange circle around it, the card for our service area should have either H4513-061, H4513-060 or H4513-009. Any other number would suggest the patient is out of their service are.
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