For information on how to submit a preauthorization for frequently requested services/procedures for your patients with Humana follow the links below.
Category: Medicare
Cigna MA Provider Directory
Per Jim there is an issue with the Cigna MA provider directory. Some providers are not listed. The problem has been reported and is being worked on. Thank you.
MLN Connects News
2024 Medicare Part B Deductible.
The annual deductible for all Medicare Part B beneficiaries will be $240 in 2024, an increase of $14 from the annual deductible of $226 in 2023.
Discarded Drugs and Biologicals:
When to Use JW and JZ Modifiers.
Read updated JW and JZ Modifier FAQs for additional clarity on billing with these modifiers (see FAQs 7, 8, and 18–22). CMS posted a new list of billing and payment codes only used for single-dose containers that may require the modifiers, depending on the setting:
Medicare Advantage Audits
In response, the Texas Medical Association has developed free CME to help member physicians prepare for such audits.
Your Patient’s MBI may change!
Over 47,000 Medicare Beneficiaries may been involved in a Data Breach that involved Personally Identifiable Information (PII) and/or Protected Health Information (PHI).
New Medicare Cards with a new Medicare Beneficiary Identifier (MBI) are being mailed out.
Ask Your Patients, If They Have A New Medicare Insurance Card!!
Renewed Form for ABN
The ABN, Form CMS-R-131, and form instructions have been approved by the Office of Management and Budget (OMB) for renewal. The use of the renewed form with the expiration date of 01/31/2026 will be MANDATORY on 6/30/23.
The Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131, is issued by providers to Original Medicare (fee for service – FFS) beneficiaries in situations where Medicare payment is expected to be denied.
The ABN is issued in order to transfer potential financial liability to the Medicare beneficiary in certain instances
CMS Efforts to Reduce Prior Auth Burden
Insurers must halve the length of time they take to respond to prior authorization requests
Insurers may no longer require preapproval for emergency behavioral healthcare.
Insurers have to explain denials and publish data on their decisions.
Patients in active treatment who change carriers must be given at least 90 days before the new insurer can require another prior authorization.
Click the below articles for more information.
Modern Healthcare
Cigna CoVid Coverage Changes
Changes in coverage effective May 12, 2023
The White House has announced their intent to end both the CoVid-19 National Emergency and Public Health Emergency (PHE) on May 11, 2023.
As a result, Cigna Commercial and Cigna Medicare Advantage plan to make the following changes on May 12, 2023:
- Authorizations for facility-to-facility transfers will again be required.
- Patient cost-share will apply to COVID-19 lab tests as well as antiviral and therapeutics approved by the U.S Food & Drug Administration (FDA).
- For most benefit plans, COVID-19 vaccines will be covered at 100 percent under the preventive benefit (same as the flu shot) when customers go to an in-network provider.
- Over-the-counter COVID-19 tests will no longer be covered.
Cigna Coverage Changes
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