Angelina Co. Vs. City of Lufkin
Angelina County
City of Lufkin
VS
POET holds a direct contract with the employer group: Angelina County
If you are unsure your physician has opt’ed into this POET contract, give us a call.
POET is working to obtain a direct contract with employer group: City of Lufkin.
POET will email opt in to physicians, when and if a contract is obtained.
YES
YES
PHCS is on both cards. But if you will look closely the card states PHCS is the “Medical Plan Network Access”. This means Angelina County is accessing physicians through a “lease network”. Angelina county employees are not insured by PHCS.
Imagine 360 is also on both cards. Imagine 360 is NOT an insurance company. They are a “third party administrator” (TPA). A third-party administrator (TPA) provides administrative services for self-funded health plan.
If you have opt’ed in to POET’s Angelina Co. agreement, please do not turn away your patients. Nothing has changed with the Angelina Co. contract. The only difference is GPA has changed it’s name to Imagine 360. However, that does not affect the current contract.
UHC Updates October 2022
Policy and protocol notice
Get the latest updates, legal mandates, state-specific news, trainings and more for
Medicare Advantage, Medicaid and Individual and Group Market plans.
TX Resources for Family
Physicians who frequently refer patients to no- and low-cost state services like health insurance and child care will find that easier now that the state has launched familyresources.texas.gov, a website that puts links to those services all in one place.
FBI Warns Healthcare Sector of Surge in Payment Scams
Cybercriminals are stealing multimillion-dollar payouts from healthcare payment processors by compromising user login credentials, the FBI warns the healthcare industry.
In recent incidents, cybercriminals used employees’ publicly available personally identifiable information and deployed social engineering techniques to impersonate care providers and gain access to healthcare portals, payment information and websites, the FBI says.
In April, an unnamed healthcare company with more than 175 medical providers discovered that a threat actor had posed as an employee and changed automated clearinghouse instructions of one of the entities’ payment processing vendors to direct payments to the cybercriminal.
“Cybercriminals are incredibly patient and have been known to spend months or longer learning about individuals and organizations in order to gain access, and then once they have access, further biding their time to gain more knowledge that allows them to increase the severity and magnitude of their crime,” he says.
Indicators of Compromise
The FBI advises entities to watch for any of a number of potential indicators that cybercriminals are attempting to gain access to user accounts.
The indicators include:
- Phishing emails targeting the financial departments of healthcare payment processors;
- Suspected social engineering attempts to obtain access to internal files and payment portals;
- Unwarranted changes in email exchange server configuration and custom rules for specific user accounts;
- Requests within a short time frame for employees to reset passwords and multifactor authentication phone numbers;
- Employees reporting they are locked out of payment processor accounts due to failed password recovery attempts.
Who ya’ gonna call?
HAVING ISSUES WITH MEDICARE CALLS?
Who do you call? A source from MGMA shared this information.
They suggest you file a complaint and email CMS leadership. Because complaints go to “low-level” administrative staff whose entire goal is to close them.
Create a complaint letter detailing your experience. Email it to CMS Administrator Chiquita Brooks-LaSure Administrator and CC to the relevant CMS leadership as follows:
CMS Administrator: Chiquita Brooks-LaSure [email protected]
Deputy Chief Operating Officer: Karen Jackson [email protected]
Director Office of Program Operations & Local Engagement: Nancy O’Connor [email protected]
Deputy Administrator and Director Center for Medicare: Meena Seshamani, M.D., PhD [email protected]
Deputy Administrator & Director Center for Medicare & Medicaid Innovation: Elizabeth Fowler [email protected]
Deputy Administrator and Director Center for Consumer Information & Insurance Oversight: Dr. Ellen Montz [email protected]
Deputy Director: Cheri Rice [email protected]
Upcoming Texas Incentives for Physicians and Professional Services (TIPPS)
REPORTING PERIOD
October 10 – November 6, 2022
Below please find information on the upcoming Texas Incentives for Physicians and Professional Services (TIPPS) reporting period (October 10 – November 6, 2022) for state fiscal year (SFY) 2023 (year [Y] 2.
- HHSC will hold a reporting webinar to provide instruction on the reporting process and template. The Y2 Round 1 reporting webinar will be held on October 13, 2022 at 2:00 PM. Please register using the link below.
- HHSC will notify participating providers when the reporting companion (instructions for using and submitting the template) and reporting template are posted to the reporting portal Bulletin Board by October 10, 2022. HHSC will post a link to the recorded Y2 reporting webinar on the bulletin Board by October 14, 2022.
- Participating providers must report data using the data measurement period of January 1, 2022 – June 30, 2022 (i.e., the first six months of calendar year 2022). All of the calendar year 2022 will be reported during Y2 Round 2 in April/May 2023
A few other links of interest:
Contact the HHSC CPP Quality Team: [email protected]
Contact the Provider Finance Department (PFD): [email protected]
Is it Posssible, Well and Sick Same Day?
Having Trouble Closing Those Gaps?
Check out these two articles from the POET InK files.
How to Code a Well Visit with a Sick Visit.
HEDIS News You Can Use
Seasonal Influenza Vaccines Pricing
The Medicare Part B payment allowance limits for seasonal influenza (flu) vaccines are 95% of the Average Wholesale Price (AWP), as reflected in the published compendia.
In hospital outpatient departments, payment is based on reasonable cost.
Annual Part B deductible and coinsurance amounts don’t apply for the influenza virus vaccinations. All physicians, non-physician practitioners, and suppliers who administer these vaccinations must take assignment on the claim for the vaccine.
Annual Influenza Vaccine season starts on August 1 and ends on July 31 of the following year.
Payment Allowances and Effective Dates by Flu Season
UHC Network News August 2022
New Smart Edit for Commercial Plans
Effective Aug. 25, 2022, a new Smart Edit will be available for commercial plans to help with coordination of benefits when you submit a claim.
How the new Smart Edit works
When you submit a claim for a member who has a commercial plan and primary health insurance with another carrier, you’ll receive 1 of the following 3 messages on your 277 Claims Acknowledgement report within 24 hours of submission:
- REJECT – This patient has primary insurance coverage with <other insurance name>, <effective Date>. Please resubmit as electronic secondary once adjudicated by the primary payor.
a. You’ll receive this message if we have the primary health insurer’s name and effective date, but don’t have the other carrier’s EOB. - REJECT – This patient has primary insurance coverage with another carrier with <effective date>. Please resubmit as electronic secondary once adjudicated by the primary payor.
a. You’ll receive this message if we have the effective date, but don’t have the other carrier’s name or EOB. - REJECT – This patient has primary insurance coverage with another carrier. Please resubmit as electronic secondary once adjudicated by the primary payor.
a. You’ll receive this message if we’re missing the carrier’s name, effective date and EOB.
What is the Smart Edits tool?
We developed the Smart Edits tool to identify billing errors within a claim so you can quickly review and repair problematic claims. We send these messages within 24 hours of a claim submission so you can review identified claims in a matter of hours instead of potential claims denials days later.
Claims that are accurately submitted and in compliance with the latest policies and regulations result in less rework, quicker approvals and faster payments.
Learn more
- For information on how to submit the primary payer EOB online, visit UHCprovider.com/ediclaimtips > Secondary/COB or Tertiary Claims and Medicare Crossover > COB Electronic Claim Requirements – Commercial
- Visit UHCprovider.com/smartedits to:
- See the list of all available Smart Edits by selecting Smart Edits Guide
- Take a self-paced training by selecting Smart Edits interactive guides
Questions?
- For information about Smart Edits claims, please contact your electronic data interchange (EDI) vendor or clearinghouse
- For additional help from us, visit our EDI Contacts page on UHCprovider.com
Humana Physician News
A Wealth of Information Just Waiting for You.
- Humana’s Neighborhood Centers offer patients one on one health education.
- Value-based care reduces acute care.
- Earn CME by attending the CMS Statin Webinar.
- Complete your annual 2022 Compliance Training.
- Many Resources and Support.
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