Humana Physician News-Q4 Edition
Effective Dec. 31, 2021, the Provider Payment Integrity (PPI) contact mailbox will be disabled.
To manage overpayments, please use the Availity Portal or call Customer Care at 800-438-7885, Monday – Friday, 8 a.m. – 8 p.m., Eastern time.
Looking for new ways to reach and engage your patients?
Humana has developed the Provider Marketing Resource Center (PMRC) so you can engage, retain and grow your practice’s patient panel, regardless of their current insurance carrier.
Contact [email protected] for access to their library of customizable patient marketing materials.
Coming Soon: PEMS
Coming Soon: TMHP Provider Enrollment and Management System (PEMS)
Providers should plan for the following changes on December 13, 2021:
- PEMS will replace Provider Enrollment on the Portal (PEP) and the Provider Information Management System (PIMS).
- PEP and PIMS will no longer be available.
- Paper applications for Texas Medicaid provider enrollment will be eliminated with the new online system.
- Providers must have access to the internet to utilize PEMS and use up-to-date internet browsers for optimum performance of the PEMS portal. Use Google Chrome or Microsoft Edge to reduce compatibility issues
CoVid-19 news from UHC
Temporary cost share waivers extended; additional billing guidance issued
CPT code for Janssen CoVid-19 Booster
October 27, 2021
The new CPT code for the booster dose of the Janssen COVID-19 vaccine joins unique CPT codes previously issued to COVID-19 vaccine booster doses from Moderna and Pfizer.
For quick reference, the new code assigned to the Janssen booster for the COVID-19 vaccine is:
0034A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5×1010 viral particles/0.5 mL dosage; booster dose
UHC Policy Updates November 2021
Community Plan
Reimbursement Policy Update Bulletin: November 2021
Medicare Advantage
Reimbursement Policy Update Bulletin: November 2021
Commercial
Medical Policy Update Bulletin: November 2021
Community Plan
Medical Policy Update Bulletin: November 2021
Medicare Advantage
Coverage Summary Update Bulletin: November 2021
UHC Link Down at this time
Medicare Advantage
Policy Guideline Update Bulletin: November 2021
UHC Link Down at this time
Two New Files Added
PHE Extended, Again
Department of Health and Human Services (HHS) Secretary Xavier Becerra has once again renewed the public health emergency (PHE) for COVID-19, effective Oct. 18, 2021. The extension will continue all telehealth waivers and other flexibilities pursuant to the PHE determination for another 90 days. Unless it is further extended, the current determination will lapse on Jan. 16, 2022. As a reminder, the Biden administration has indicated that it intends to provide the healthcare community with 60 days’ notice prior to allowing the PHE to lapse.
Attention: Codes deleted from ICD-10
ATTENTION!
Please Read!
Thirty-nine codes were deleted from the 2022 ICD-10 code set effective October 1, 2021.
Three of these 39 codes are billed by PCPs quite frequently:
M54.5 (low back pain)
R05 (cough)
R63.3 (feeding difficulties)
POET has been told, “Cigna Medicare is denying the whole claim as “inappropriate diagnosis code” when billed with one of these deleted codes. “
Texas Prepares to Inplement “GOLD CARD”
HAD YOUR FILL OF BURDENSOME PRIOR AUTHORIZATIONS?
For the Nitty Gritty of how House Bill 3459 is supposed to make your life easier follow this link to the TMA article by Joey Berlin.
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