For information on how to submit a preauthorization for frequently requested services/procedures for your patients with Humana follow the links below.
Superior Prior Auth Changes Eff. 1/1/2024
For some services, utilization review is necessary to determine the medical necessity and appropriateness of a covered health care service for Superior HealthPlan’s managed care members. For those services, utilization review is performed BEFORE (prior authorization), during (concurrent review) or after (retrospective review) the service is delivered.
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:
Aetna OfficeLink Updates, Oct. 1, 2023
Healthcare Common Procedure Coding System (HCPCS) modifiers FX and FY
Effective January 1, 2024, we will reduce payment for radiology procedures billed with modifiers FX and FY to align with the Centers for Medicare & Medicaid Services (CMS) guidelines.
• Modifier FX (X-ray taken using film): A 20% payment reduction applies to the technical component (and the technical component of the global fee).
• Modifier FY (computed radiography X-ray): A 10% payment reduction applies to the technical component (and the technical component of the global fee).
Reimbursement for code A9279
(monitoring feature/device)
Effective January 1, 2024, Aetna® will no longer reimburse for code A9279, since it is considered statutorily non-covered.
Aetna Monthly OfficeLink Update
Cigna MA on CoVid Testing Coverage and Reimbursement.
The waiver for customer cost-share for physician visits for test (both in and out of network) ended May 11, 2023. However, laboratory tests for CoVid ordered by the provider will continue to be covered with no out-of-pocket costs following the end of the PHE on May 12, 2023.
Medicaid and CHIP Program Revalidation
IMPORTANT:
During the Public Health Emergency (PHE), Provider
Revalidation was waived by HHSC.
The PHE ended May 11, 2023
Beginning May 12, 2023, Provider Revalidation Requirements were resumed.
Providers must ensure Medicaid and/or CHIP enrollment revalidation is completed on or before the provider’s scheduled revalidation date.
Providers that do not complete the revalidation process by their deadline are DISENROLLED from all Texas state healthcare programs, including Medicaid and/or CHIP managed care programs.
Visit the Texas Medicaid & Healthcare Partnership (TMHP) Provider Enrollment webpage to view and confirm your upcoming Medicaid and /or CHIP program revalidation date, verify current enrollment is active and verify all information in the PEMS system is accurate.
Health Plan Representatives Updated
The Health Plan Representative list has been updated. Please give a copy to everyone that might need it in your office.
Medicare Advantage Audits
In response, the Texas Medical Association has developed free CME to help member physicians prepare for such audits.
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