Get the Latest Cigna Updates.
Nonphysician Practitioners and Scope of Practice
TMA Ask the Expert Virtual Event
August 17th at 1 PM
How to Delegate to Nonphysician Practitioners.
Nonphysician Practitioners and Scope of Practice, a TMA Ask the Expert virtual event, will teach participants how to comply with state laws and regulations on delegating and supervising prescriptive authority. Join Carra Benson, TMA manager of practice management and reimbursement services; Dan Finch, TMA vice president of advocacy; and Julian Rivera, health law partner at Husch Blackwell, on Aug. 17 at noon CT.
UHC Network Bulletin Overview 8/2021
Your NOTICE of protocol
and policy changes
from UnitedHealthcare
Medical policy updates: August 2021
This month, you’ll find updates for Medicaid, Medicare, Exchange and commercial plans.
Prior authorization and notification requirement updates
We’re making changes to certain advance notification and prior authorization requirements that are available for you in the 2021 Summary of Changes.
Reimbursement policy updates: August 2021
This month, you’ll find updates for Medicaid and commercial plans.
Specialty Medical Injectable Drug program updates: August 2021
See the latest updates to requirements for Specialty Medical Injectible Drugs for UnitedHealthcare members.
Prior authorization code updates for commercial plans
Effective Nov. 1, 2021, we are adding new codes to the prior authorization list for UnitedHealthcare commercial plans including All Savers, River Valley, Neighborhood Health Partnership, UnitedHealthcare West, MidAtlantic Health Plans
In Accurate Medicare Claim DENIALS!!
Novitas Solutions, the Medicare payer for Texas, announced that a system error has caused the improper rejection of Medicare Part B claims submitted on or after July 6. Physicians who received a claim rejection message should not resubmit claims at this time. Novitas says it is researching a claims processing system fix. TMA is monitoring the problem.
IF YOUR TREK TO COLLECT
is coming up with more dead-ends and reworks than you have ever had in your life!!!
There is a ray of hope!
Do you remember the old Texas Medical Association (TMA), Hassle Log?
It has a new name.
“Reimbursement Review and Resolution (RRR) services” (because hassle log was too hard, lol).
If you are a TMA member, this is a great resource.
Attached is the paperwork you will need to submit your issue. Just follow the links.
POET has recently reached out to TMA using this resource and so far it has been pretty simple.
Incident-To Billing Got You Confused?
Texas Medical Association (TMA) can help!
“Incident-to” billing – when services delivered by a nonphysician practitioner are billed under a supervising physician’s credentials – can be confusing, and Texas Medical Association staff are routinely fielding questions about those unique arrangements.
To help you avoid any billing blunders, TMA has released an education sheet on incident-to billing (login required), with a basic overview of guidelines and requirements.
The two-page guide addresses incident-to billing for Medicare, Medicaid, and commercial plans, along with helpful links to resources that can help answer your questions and resolve billing snags.
Download the incident-to education sheet – along with other resources on billing, collection, claims, and more – on TMA’s Educational Quick Tips page.
HealthSpring Insurance Card
You may have noticed the Cigna MA (HMO) insurance card no longer sports the “HealthSpring” name.
Here is a tip.
There are only three customer benefit plans (HMO) for our service area.
- 2021-TX-H4513-061-Preferred (HMO) – Medicare A, B, & D coverage
- 2021-TX-H4513-060-TotalCare (HMO DSNP) – Medicare/Medicaid A, B, & D coverage
- 2021-TX-H4513-009-Fundamental (HMO) – Medicare A & B coverage only (no part D); formerly known as the Advantage plan
Where you see “contract/PBP” with the orange circle around it, the card for our service area should have either H4513-061, H4513-060 or H4513-009. Any other number would suggest the patient is out of their service are.
Automate Your Revenue Cycle and Avoiding EFT Fees
ARE YOU PAYING TO GET PAID?
OR
Would you like to lodge a complaint against a health plan?
Frontline Resource for helping low-income, Uninsured Texas Women
From Women’s Health
Reference Sheet Outlines Public Coverage Options for Uninsured Women |
The Texas Collaborative for Healthy Mothers and Babies has developed a reference sheet for frontline health care workers to help low-income, uninsured women in Texas potentially find coverage through one of the state’s public health insurance programs. |
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