Category: Medicare
UHC Policy Updates for March 2022
Just click the button to check out the latest from UHC.
Quarterly Update for Clinical Laboratory Fee Schedule (CLFS)
Quarterly Update for Clinical Laboratory Fee Schedule (CLFS) and Laboratory Services Subject to Reasonable Charge Payment
POET Is Seeing a Trend, UPDATE
On January 5th, Sir Seymore posted on Ink that POET is seeing a trend from Physician Offices that are trying to get a referral from Cigna MA.
Please scroll down to review that post for details.
POET received this information from Cigna MA: “Unfortunately, we’re experiencing a known enterprise-wide issue within the MHK/HSConnect platform that is affecting how many of our participating specialists are reflecting in the dropdown box or search box when attempting to generate a referral. The MHK/HSConnect team is working towards remediation but I have not yet heard when the expected date for completion might be.”
Just a reminder: SCPs do not need a referral due to the Public Health Emergency (PHE). The PHE has been extended until April 16, 2022.
PCPs and SCPs you are welcome to confirm participation with POET or Leslie.
Per Cigna MA, you should be able to manually enter the specialists’ (SCP) name/NPI for a referral.
CIGNA MA Information Update from POET
POET has received a few calls regarding the Cigna MA PPO plan that came into effect January 1, 2022.
- To the left is a screen shot of one PPO product’s card. (I’m sorry it is not to pretty.)
- No PCP is required.
- Referrals are not required
- Providers are still responsible for receiving PRIOR AUTHORIZATION.
You may have noticed the Cigna MA insurance card no longer sports the “HealthSpring” Logo.
The below list are for Provider use only. Not to be distributed to Patients
HMO Customer Benefit Plans for Our Service Area
PPO Customer Benefit Plans for Our Service Area
- Cigna Preferred Medicare HMO
- H4513-061-001
- CignaTotalCare HMO D-SNP
H4513-060-001 - Cigna Fundamental Medicare HMO H4513-009-000
- Cigna Preferred Savings Medicare HMO
H4513-066-000
- Cigna True Choice Medicare PPO
H7849-038-000 - Cigna True Choice Plus Medicare PPO
H7849-062-000
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
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