ASK THE EXPERT
TMA RESOURCES |
Ask the Expert: End of the Public Health EmergencyOn March 29 via Zoom, join TMA experts in this interactive Q&A session as they discuss how best to prepare your practice for upcoming changes as the public health emergency winds down on May 11. They will discuss the impact on Medicaid coverage, telehealth, and COVID vaccines and treatments for which you can earn CME. Send your questions in advance. Register now. |
Superior Risk Adjustment Training
Superior will be hosting a series of webinars to assist providers with Risk Adjustment Documentation and Coding. All levels of clinicians and billing and coding staff are encouraged to attend.
Health Plan – Representative Update
Please print this updated list. Keep it handy for working claim issues. Many have changed.
HHS Announces End of PHE
According to HHS.Gov Fact Sheet: COVID-19 Public Health Emergency Transition Road Map
The Public Health Emergency (PHE) for COVID-19 is scheduled to expire at the end of the day on May 22, 2023.
Just in Aetna OfficeLink Update
Changes to Aetna’s Commercial drug list BEGIN ON JULY 1st
“On July 1, 2023, we’ll update our pharmacy drug lists. Changes may affect all drug lists, precertification, step therapy and quantity limit programs.
You’ll be able to view the changes as early as May 1. They’ll be on our Formularies and Pharmacy Clinical Policy Bulletins page.”
Ways to request a drug prior authorization:
- Submit your completed request form through our Availity provider portal.*
- For requests for non-specialty drugs, call 1-800-294-5979 (TTY: 711). Or fax your authorization request form (PDF) to 1-888-836-0730.
- For requests for drugs on the Aetna Specialty Drug List, call 1-866-814-5506 or go to our Forms for Health Care Professionals page and scroll down to the Specialty Pharmacy Precertification (Commercial) drop-down menu. If the specific form you need is not there, scroll to the end of the list and use the generic Specialty Medication Precertification request form. Once you fill out the relevant form, fax it to 1-866-249-6155.
For more information, call the Provider Help Line at 1-800-AETNA RX (1-800-238-6279) (TTY: 711).
UHC March Overview is Here.
UHC Network News is published twice a month.
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.
Prevent Improper Code Bundling
Physicians can take advantage of a new Medicare tool to sort through service codes that can be bundled together for claims payment – and AVOID improper billing.
The CMS recently released the National Correct Coding Initiative (NCCI) procedure-to-procedure (PTP) lookup tool to promote accurate code-bundling and prevent improper payment of Medicare Part B and Medicaid claims when incorrect code combinations are reported.
Available via Texas’ Medicare contractor Novitas Solutions, the tool is further designed to help physicians identify when certain pairs of codes are subject to automated edits.
AND FOR EVEN MORE TOOLS
CLICK ON ANY OF THE BUTTONS BELOW
CIOX What Are Your Options
Did you say Cyclops?
Or was that Sick Ox?
No, Silly. CIOX
Medical records can be submitted through the following options:
1. PROVIDER PORTAL:
Upload the medical records to Ciox’s secure
provider portal at https://www.cioxlink.com
using the following credentials:
Username: C34765843
Password: eeE4^fe8
2. REMOTE EMR Retrieval:
Set up secure remote connection from a
provider site’s EMR directly to Ciox for timely
off-site remote retrieval of records with
trained associates at Ciox by
contacting 1-877-445-9293
3. ONSITE Chart Retrieval:
Schedule on-site retrieval with a complimentary Ciox
Chart Retrieval Specialist or review any aspects of the on-site retrieval services at Ciox by
contacting 1-877-445-9293
4.FAX:
Send secure faxes to 1-972-957-2216
5. MAIL:
Mark “Confidential” on the envelope and mail the medical records to: CIOX Health
2222 W. Dunlap Ave. Phoenix, AZ 85021
Humana Physician News Q1 2023
Just to mention a few topics:
- Financial Assistance for patients
- Real-time Benefit check
- Medication reconciliation for reduced hospital readmission
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