Category: Medicare
More from HealthSpring HCSC
New Benefit Plans will roll out under the HealthSpring (HS) name during the 2025 Annual Enrollment Period (AEP)
Beginning in 2026, you will see members enrolled in HealthSpring benefit plans. But until then physician staff and HS will continue to communicate through the Cigna Healthcare Channels, including the Provider Newsroom.
In September of this year (2025) HS will add a home page for providers. After that HS will continue to add resources to prepare the physician office and HS members for January 2026. Check out HealthSpring.com
CHS Terms HealthSpring Contract
POET has been informed that Woodland Heights Medical Center, a CHS hospital, has notified HealthSpring of its intent to terminate its contract. The contract in question is a national agreement held by CHS.
While a last-minute agreement remains a possibility, the termination is currently scheduled for August 28.
This termination will also include the Diagnostic Center of Woodland Heights.
We have requested to be kept informed of any updates or changes.
CHS Terms HealthSpring Contract!
POET has been informed that Woodland Heights Medical Center, a CHS hospital, has notified HealthSpring of its intent to terminate its contract. The contract in question is a national agreement held by CHS.
While a last-minute agreement remains a possibility, the termination is currently scheduled for August 28th
This termination will also include the Diagnostic Center of Woodland Heights.
We have requested to be kept informed of any updates or changes.
UHC July Overview
Policy and protocol updates
Medical policy updates
Medical policy updates for July 2025 for the following plans: Medicare, Medicaid, Exchanges and commercial.
Reimbursement policy updates
See the latest updates for reimbursement policies.
Specialty Medical Injectable Drug program updates
See the latest updates to requirements for Specialty Medical Injectable Drugs for UnitedHealthcare members.
Pharmacy and clinical updates
Access upcoming new or revised clinical programs and implementation dates for UnitedHealthcare plans
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.
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