For information on how to submit a preauthorization for frequently requested services/procedures for your patients with Humana follow the links below.
Category: Medicare
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
UHC April Monthly Overview
For Texas:
Starting June 1, 2023, Optum will manage prior authorization and step therapy requests for prescription medications for Texas residents with pharmacy coverage.
UHC Updates
Medicare vs Inflation
As part of a broader push for Medicare payment reform, the Texas Medical Association, along with the American Medical Association and 133 national specialty and state medical associations, recently called on Congress to index Medicare physician payments to inflation.
POET Says Farewell
As of March 31st, Leslie Anders is no longer with Cigna MA.
Please direct Cigna MA issues and questions to:
Jim Denman
(936) 635-0612
Please be patient, Jim will be filling both positions until Cigna finds a replacement.
Farewell
Medicare Patient Additional Support
Have You Identified Patients That Need Additional Support?
Physicians may refer Cigna Medicare patients to Cigna’s multiple Care Management (Patient Support) programs. Simply by sending an email to the Care Management team at [email protected]
To request an eligibility assessment review for your patient or learn more, contact Cigna Medicare Advantage patient support programs:
- email: [email protected]
Include:
- Provider Name and Phone #
- Patient Name
- Patient Healthplan ID #
- Any additional information we may need relevant to medical, pharmaceutical, behavioral, or SDOH needs
Remember to use secured email when sending patient PHI or diagnostic information in order to protect patient information.
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