Category: Medicare
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.
Special Enrollments Periods
SEP for Individuals Affected by a Disaster or Emergency
Effective January 1, 2021, an SEP exists for individuals affected by a disaster or other emergency declared by a Federal, state or local government entity who were unable to, and did not make an election during another valid election period. This includes both enrollment and disenrollment elections.
Claims Hold!
Temporary Claims Hold Pending Congressional Action to Extend 2% Sequester Reduction Suspension
In anticipation of possible Congressional action to extend the 2% sequester reduction suspension, we instructed the Medicare Administrative Contractors (MACs) to hold all claims with dates of service on or after April 1, 2021, for a short period without affecting providers’ cash flow. This will minimize the volume of claims the MACs must reprocess if Congress extends the suspension; the MACs will automatically reprocess any claims paid with the reduction applied if necessary.
Billing for Services when Medicare is a Secondary Payer Feb. 23, 2021
This MLN Matters® Special Edition (SE) Article is for physicians, hospitals, Skilled Nursing Facilities (SNFs), suppliers and other providers who bill Medicare Administrative Contractors (MACs) or Durable Medical Equipment (DME) MACs for services provided to Medicare beneficiaries.
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