When the PHE Expires, What then?
How to Reverify Patients’ Medicaid Eligibility
When the Public Health Emergency Ends
With the federal public health emergency (PHE) slated to expire at the end of 2021, millions of Medicaid patients across the U.S. are at risk of losing their coverage. Texas physicians should prepare by scheduling services as soon as possible for such patients and evaluating the financial impact of potential increases in uncompensated care. They also should expect to reverify patients’ Medicaid eligibility when the PHE expires.
Physicians can reverify patients’ eligibility electronically through the Texas Medicaid & Healthcare Partnership (TMHP) Electronic Data Interchange, TexMedConnect, or the Medicaid Client Portal. They can also call the TMHP Automated Inquiry System at (800) 925-9126.
Biden Vaccine Mandate Plan
Earlier this month, President Joe Biden introduced a six-point plan that mandates COVID-19 vaccines for millions of Americans.
Many details of the plan are still being developed as specific regulations are written, but at least one aspect of the plan is clear: The vaccination mandate for “over 17 million health care workers at Medicare and Medicaid-participating hospitals and other health care settings,” largely does not apply to small physician practices, according to Texas Medical Association analysis
HAVING UHC CLAIMS ISSUES?
If You Are Having UHC OON
Claims Issues,
Please Read This!
POET is working with the TMA regarding UHC OON issues. They have confirmed the following:
If you are billing with a GROUP TIN:
You will not utilize the group NPI# in box 33a – if you do, it will process OON. Only the individual physician’s NPI# should be listed here since your physicians has an individual contract with UHC, not a group contract.
For those claims processing OON, if timely filing limits have not passed you should file corrected claims with the individual NPI in box 33a.
When verifying whether a physician is in or out of network, you should not provide the group NPI#.
This only reflects physicians who are in the POET All Products contract. If you have a direct, POET is unable to direct you in this matter.
2nd Regulation Released Implementing No Surprises Act
On Thursday, Sept. 30, the Office of Personnel Management and the Departments of Health and Human Services, Labor, and Treasury, released the second regulation implementing provisions of the No Surprises Act. On Dec. 27, 2020, the No Surprises Act was signed into law with the goal of protecting patients from receiving surprise medical bills. This rule follows prior rulemaking outlining patient protections against surprise medical bills, establishing out-of-pocket limits, and notice and consent requirements.
This rule implements dispute resolution processes for providers, patients, and health plans and takes effect Jan. 1, 2022. Consistent with the intent of the law and previous rules from the Administration, patients continue to remain harmless from outstanding surprise medical bills.
Follow these links for more information from CMS.gov.
CignaforHCP Training on Newest Features.
Online Appeals and Claim Reconsideration and Procedure Code Lookup,
Interactive Staff Training.
OOPS!! Cigna MA Letter ERROR
Apparently a letter went out to some Cigna members that was supposed to be alerting them that the contract with the CHS hospital (WHMC) is being terminated. There was an error in the letter because it stated “Your doctor is leaving the network”. This has caused a flurry of concern and confusion in some areas, as you might imagine. A corrected letter, further clarifying that the entity being terminated is the hospital and not the physician, is expected to go out Oct. 5th.
UHC No Longer Sending PRAs by Mail
PRAs (Provider Remittance Advice) will go paperless by region starting Nov. 12.
Please review this map for effective dates and exclusions by geographical region.
HealthSelect ERS
Effective Sept. 1, 2021, HMO plans will no longer be an enrollment option under the Texas Group Benefit Program. All current subscribers and dependents enrolled in one of the HMO plans will be automatically enrolled in HealthSelect of Texas administered by Blue Cross and Blue Shield of Texas, unless they elect otherwise during their summer enrollment period
Participants who are transitioning from an HMO plan will have a 90-day referral grace period and will receive in-network benefits if they see an in-network specialist without a referral during this timeframe. After Nov. 30, 2021, if there is not a referral on file with BCBSTX, the specialist visit will be covered at the out-of-network benefit level, even if the specialist is in-network.
Effective Sept. 1, 2021, certain procedure codes are being removed from the list of services that require prior authorization for HealthSelect of Texas® & Consumer Directed HealthSelectSM participants. You can review a list of the codes being removed here 
. BCBSTX is currently working on system updates to reflect this change.
Remember to use Availity®
or your preferred vendor to check eligibility and benefits before rendering services. This will help you confirm coverage details and prior authorization requirements and determine if you are in-network for the member’s policy. Refer to Eligibility and Benefits for details.
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