Cigna Network News 3rd Quarter 2023
Claim status notifications available on the CignaforHCP.com Message Center
7 Tips to Combat Embezzlement
Reducing medical practice embezzlement risk with cash controls
POET is having Phone Issues
If you have an emergency issue and have one of cell numbers, please use those. If not you will have to email. Sorry for the inconvenience.
Update: we are back up and running.
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!!
BCBS Pharmacy Quarterly Update
Changes Effective October 1, 2023
Health Plan Representatives Update 8/3/2023
The Health Plan Representative List has been updated. Feel free to download and keep a copy in all the areas where it is needed.
UHC Network News
13 Reasons a Claim is Denied
1). A duplicate claim was submitted when a practice hasn’t received reimbursement.
2). The patient isn’t eligible for services because their health plan coverage ended, and the patient hasn’t shown proof of new insurance.
3). The patient hasn’t met his/her deductible for the year.
4). Some services are bundled. For example, laboratory profiles with multiple tests don’t qualify for separate reimbursements, or an all-encompassing rate covers the minor procedures and the pre- and post- procedure visits. The provider receives one combined payment.
5). The benefit has been exceeded, such as the maximum allowed number of physical therapy visits covered by the health plan within a calendar year.
6). The claim form is missing a modifier, or modifier(s) are invalid for the procedure code (as in the case of bilateral codes billed on both sides).
7). An inconsistent place of service is marked on the claim form, such as an impatient procedure billed in an outpatient setting.
8). A particular service isn’t covered under the plan’s benefits, or there appears to be a lack of medical necessity. In another example, there could be a mismatch between the actual diagnosis and the service performed.
9). The claim is deficient in certain information. It may be missing prior authorization or the effective period within which the pre-approved service must be provided for the reimbursement to occur.
10). There is a coding data error with mismatched totals or mutually exclusive codes.
11). It may be necessary to coordinate benefits when dual coverage issues arise, such as with secondary insurance or worker’s compensation.
12). The filing deadline has passed. If a claim isn’t submitted to the insurer within the permitted time frame, it is likely to be rejected. The limit to file can be as short as 90 days from the date of service.
13). Errors or typos were made while collecting pertinent information from the patient or during the data entry process for a claim.
More on DEA Training
Please click on this link “DEA Registered-Practioners” to read the Letter from the Drug Enforcement Administration (DEA).
Pay close attention to “Group 2”. There are other ways to satisfy the training requirement.
Additional Links:
New Requirement – DEA Registered Practioners
HEADS UP!
All practitioners registered with the Drug Enforcement Agency (DEA) will be responsible for fulfilling a one-time, eight-hour training requirement on the treatment or management of patients with opioid or other substance use disorders. Practitioners need to satisfy this requirement before their initial or next scheduled DEA registration submission on or after June 27, 2023.
There are multiple ways that a practitioner may satisfy this new requirement — the DEA sent a letter outlining these options and providing a list of accredited groups that may provide trainings. The Substance Abuse and Mental Health Services Administration (SAMSHA) has additional information about frequently asked questions. MGMA Government Affairs will discuss this policy in more detail during our upcoming mid-year policy update webinar.
PLEASE CLICK ON THE LINKS IN THE ABOVE PARAGRAGH FOR MORE INFORMATION.
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