Physician Directory Update
Who needs Google Maps, when you can download the Physician Directory from the POET INK files?
To download your front desk copy, just click.
UHC New EDI Edits for MA Claims
EDI claim edits now notify you of missing or mismatched information.
As of Aug. 28, 2021, the new payer-level edits for Electronic Data Interchange (EDI) 837 claim submissions provide alerts of specific information that may be missing or doesn’t match data contained in our systems.
How will you be notified of claim issues?
Claims that are rejected for these edits will appear on your claims rejection report, also known as a 277CA report. UHC is no longer mailing letters about claim submissions that need attention. Instead, your clearinghouse will be responsible for notifying you of any issues.
What do you need to do?
Ensure you are receiving these messages from your clearinghouse. Claims that are rejected should be corrected and resubmitted electronically to be accepted into our processing system for adjudication.
KNOW YOUR TRS
This Information Pertains to POET Contracts ONLY!
Blue Choice PPO, Blue Essentials HMO, or UHC MA?
TRS Plan Name:
TRS-Care Medicare Advantage
TRS-Care Standard
TRS-ActiveCare Primary
TRS-ActiveCare Primary Plus
TRS-ActiveCare HD
TRS-ActiveCare 2
Scott and White Health Plan
South Texas HMO
West Texas HMO
POET Agreement:
UHC All Products
Blue Choice PPO
Blue Essentials HMO
Blue Essentials HMO
Blue Choice PPO
Blue Choice PPO
NO
Blue Essentials HMO
Blue Essentials HMO
Alpha Prefix or Plan:
80840
T3X
T2U
T2U
T2S
T2S
U/N
U/N
U/N
Plan Year:
2021
2021
9/1/2021-8/31/2022
9/1/2021-8/31/2022
9/1/2021-8/31/2022
9/1/2021-8/31/2022
9/1/2021-8/31/2022
9/1/2021-8/31/2022
9/1/2021-8/31/2022
You will probably not see the last 3 in italics. They are regional and not offered locally.
Important Cigna CoVid Updates
Since the COVID-19 pandemic began, Cigna has taken important steps to deliver accommodations to providers and customers, helping to ensure that our customers have continued access to COVID-19 screening, testing, treatment, and vaccinations in safe settings. Please click on the button to view this update. |
CMS Web-Based Learning
Have you and your staff completed your Annual Fraud, Waste and Abuse (FWA) training for 2021 as outlined in the 2021 Medicare Compliance Program Guidelines Attestation for Downstream Entities?
- Fraud, Waste and Abuse (“FWA”) Training
Fraud, Waste and Abuse Training was provided in 2021 to all of our employees, contractors and downstream entities who are assigned to work on Medicare business. This occurred initially during the orientation period and annually thereafter. Records of Fraud, Waste and Abuse Training completion are maintained for at least 10 years
CMS has recently revised their Multimedia Web-based Training.
And it’s free
POET Closure
POET will be closed today in honor of Labor day.
Your Notice of Protocol and Policy Changes from UHC
- Medical Policy Updates Effective 9/1
- Prior Authorization and Notification Requirement Changes
- Reimbursement Policy Updates
- And More
Humana’s Covid-19 Response
An important message regarding
Humana’s COVID-19 response:
ADMINISTRATIVE UPDATE Sept. 1, 2021
Humana is suspending authorization requirements for skilled nursing facilities (SNFs) and
long-term acute care (LTAC) for Medicare Advantage and commercial members discharging
from hospitals in the state of Texas through Oct. 1, 2021.
Important details:
- Authorization suspension, as outlined herein, will continue through Oct. 1, 2021.
- This suspension applies to participating/in-network providers only.
- Please provide notification of admission within 24 hours to allow us to track our members’ progress. You will receive
an approval when you submit the notification. - No other services requiring prior authorization are included in this suspension.
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