Category: Medicare
A Familiar Name Returns to Healthcare
In a landscape cluttered with brand mashups, logo overload, and forgettable names—WellThis, WellThat, PlusThis, PlusThat, and the never-ending bowl of Alphabet Soup—clarity is a breath of fresh air. Amidst the noise, we’re proud to reintroduce a name that brings familiarity, trust, and simplicity back into focus: HealthSpring
More on HCSC Acquisition of Cigna MA
Can this get anymore confusing?
🏢 What is HCSC?
Health Care Service Corporation (HCSC) is:
The largest customer-owned (non-investor-owned) health insurer in the U.S.
A licensee of the Blue Cross and Blue Shield Association (BCBSA).
It operates five Blue Cross Blue Shield health plans:
Blue Cross and Blue Shield of Illinois
Blue Cross and Blue Shield of Texas
Blue Cross and Blue Shield of New Mexico
Blue Cross and Blue Shield of Oklahoma
Blue Cross and Blue Shield of Montana
🔗 What is the Relationship Between HCSC and BCBS?
BCBS is a national brand and association, not a single company. It licenses its brand to independent regional companies.
HCSC is one of those companies, and it owns and operates the BCBS plans in the five states listed above.
So, when someone has BCBS of Illinois, for example, their insurance is actually managed and provided by HCSC.
Acquisition Completed March 19, 2025.
It has been stated:
- Members will have the same plan, benefits, and network structure.
- No changes are expected for 2025.
- Members should not expect any changes in coverage of out-of-pocket cost.
- And the one thing we hope will change is, BCBS says we can still expect the same level of service.
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HEADS UP! Rider 32 Transition
Effective September 1, 2025
Texas Health and Human Services Commission will implement Rider 32, which will transition Medicaid only services for dually eligible members from a fee-for-service model to a managed care delivery system.
This change affects services provided to members who are eligible for both Medicaid and Medicare. It applies only to those Medicaid services not covered by Medicare.
Providers will bill the MCO for Medicaid wrap-around services provided to dually eligible members.
Wrap-around services include all Medicaid services not covered by Medicare. They are limited to those already covered under managed care for Medicaid-only members.
Humana
TIPS, TRICKS AND HELPS
PREAUTHORIZATON LISTS (PAL):
Lists of services and medications effective July 1, 2025, that may required preauthorization for members with Medicaid, Medicare Advantage, and dual Medicare-Medicaid coverage are now available.
Easily determine if a prior authorization is required with Humana’s search tool. Search by Current Procedural Terminology (CPT®) codes, procedures or generic drug name(s). Remember to verify benefit coverage in Availity Essentials
Availity Essentials Introduces Check Claim Status Feature:
Availity has enhanced its Eligibility and Benefits (E/B) page by adding a Check Claim Status feature.
What you can expect:
- Improved efficiency and accuracy: The check Claim Status tool pre-populates your patient’s information, ensuring accuracy.
- Time savings: You can access claim status with one click- saving time and effort
Medicare Preventive Services – Revised
The above link will lead you to MLN Educational Tool, where you can click a service and see the changes.
Superior: Appeal Submissions
IMPORTANT: Post-Service Medical Necessity Appeal Submissions
Superior HealthPlan would like to remind providers that post-service Medical Necessity Appeals must be mailed or faxed using the submission information below. Submissions must include the reason for appeal and any additional clinical information for appeal review..
Centene Management Company
ATTN: Medical Management Appeals
5900 E. Ben White Blvd
Austin, Texas 78741
Fax number: 1-866-918-2266
Post-service appeals for reconsideration of a Medical Necessity Denial on behalf of a member should not be sent to the Claims Appeal address.
For questions about post-service Medical Necessity Appeals, providers can contact 1-877-398-9461.
Submit 2024 MIPS Data by April 14th
The data submission period for Medicare’s 2024 Merit-Based Incentive Payment System (MIPS) performance yeard has been extended to April 14th at 7 pm CT.
At Stake is a pay cut of up to 9% in the 2026 payment year.
Cigna Medicare Business Acquisition Completed
Well, it is final. As of today, March 19, 2025 Health Care Service Corporation
(HCSC) has acquired Cigna’s Medicare operations.
HCSC has acquired Cigna’s Medicare businesses, including Medicare Advantage, Cigna Supplemental Benefits, Medicare Part D, and CareAllies.
It has been stated:
- Members will have the same plan, member ID, benefits, and network structure.
- No changes are expected for 2025
- You should not expect any changes in coverage levels or out-of-pocket cost.
- And the one we all hoped would change, BCBS says we can still expect the same level of service.
Humana’s Contract Numbers
Knowing the Medicare Advantage (MA) Contract number of the plans your office has opt’ed into can be a big help.
Some may say what is a MA contract number? Or you may have heard it called an H number.
The Centers for Medicare and Medicaid Services (CMS) is responsible for identifying each Medicare Advantage C plan with a unique contract number. This number is assigned to the insurance company during the approval process. For local managed care contracts, the number begins with an ‘H’ or a ‘9″.
Below are your H numbers for the Humana-POET contract.
The next time you are in doubt about a Humana Card, look for one of these numbers on the front of the card.
Humana Gold Plus H0028-041 (HMO)
HumanaChoice Giveback H5216-358 (PPO)
Humana USAA Honor Giveback H5216-348-000-2025 (PP0) This is the only Humana Military card under the POET Contract.
This isn’t the best example of a Humana card, but you can see the H number in the bottom right hand corner.
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