A pair of big wins capped a successful past week for medicine, as the Texas House of Representatives on Friday afternoon signed off on both curbing the impositions of prior authorization and updating the state’s immunization registry.
THRIVE
THRIVE CareAllies’ Provider Newsletter May 2021
Education inside: Obtain Assistance with Coding Accuracy and Documentation, one-on-one education, coding reference tools. Get set up for remote access, email [email protected].
Resource Material inside:
- CoVid Vaccine Flyers
- Call us first: Poster, Wallet Card, Wearable Button, etc.
- NO-SHOW: Poster and Wallet Card (customizable)
Email CareAllies at [email protected] with any topic suggestions for this (your) newsletter.
THRIVE
Step Therapy Requirement
Cigna Medicare Advantatge
The goal of step therapy is to help achieve lower drug prices while maintaining access to drugs for patients.
Certain Part B drugs that currently require precertification will also require step therapy.
The list of drugs that require step therapy can change throughout the plan year.
Cigna MA
Cigna Updates
Cigna is pleased to announce we are expanding our Musculoskeletal and Pain Management Program to include select Cigna Medicare Advantage customers.
Beginning June 1, 2021, precertification requests for affected services, including major joint surgery services related to the hip, knee, and shoulder and interventional pain management procedures must be submitted to eviCore instead of Cigna.
CIGNA MEDICARE ADVANTAGE PRIOR AUTHORIZATION PROGRAM – ORIENTATION SESSION SCHEDULE.
Cigna Medicare Advantage has partnered with eviCore healthcare to provide patients with access to high quality, medically appropriate care that is consistent with evidence-based treatment guidelines.
The following procedures will require prior authorization for patients covered by Cigna Medicare Advantage
- Major Joint Services (Hip, Knee, Shoulder)
- Interventional Pain Management Procedures
eviCore healthcare will be leading online orientation sessions designed to assist you and your staff with the new program. For times and how to register click here.
BCBS UPDATE 5/12/2021
SA Modifier and Midlevel Provider Contracting Update.
On January 19, 2021, Blue Cross and Blue Shield of Texas (BCBSTX) posted an article regarding contracting and credentialing midlevel providers and the upcoming implementation of the ClaimsXtenTM edit of the SA modifier for non-payable services resulting in the SA modifier being non-reimbursable. This edit has not been implemented and there are currently no plans for future implementation of this edit.
SA Modifier Reminder
The SA modifier should be used:
- By the supervising physician, when he/she is billing for services rendered by a Physician Assistant (PA), Advanced Practice Nurse (APN), Certified Registered Nurse First Assistant (CRNFA) or Licensed Surgical Assistant (LSA).
- On claims submissions by PA or APN’s when billing under their own NPI number for assisting with any other non-surgical procedures.
This information can be found in the Clinical Payment and Coding Policies – Modifier Reference Guideline located on the provider website. Information about the reimbursement amount for the SA modifier is available in the Reimbursement Schedules and Related Information (Secure Content) area of the General Reimbursement information page. You will need a password to access this information which can be obtained from your local Network Management Office location.
SA Modifier Update
Cigna MA 2nd Qtr News 5/11/2021
Feature Article: Engaging with Patients Virtually, Cigna’s Virtual Care Reimbursement Policy
Policy Updates:
- Preventive Care Services
- Precertification
- Clinical, Reimbursement, and Administrative
General News
- Claim Denial preventive tips
- Appeal Reminders
- and many more to numerous to add
Webinar Schedule for Digital Solutions:
| Topic | Date | Time (CT) | Length | Meeting # |
|---|---|---|---|---|
| Eligibility and Benefits /Cigna Cost of Care Estimator | Wednesday, May 12, 2021 | 12:00 | 60 min | 179 626 8334 |
| EFT Enrollment, Online Remittance, and Claim Status Inquiry | Monday, May 17, 2021 | 11:00 | 60 min | 179 602 5133 |
| Online Appeal and Claim Reconsideration | Wednesday, May 19, 202 | 11:00 | 60 min | 179 487 2665 |
| Website Access Manager Training | Wednesday, May 26, 2021 | 11:00 | 60 min | 179 079 6479 |
| CignaforHCP.com Overview | Tuesday, June 1, 2021 | 1:30 | 90 mins | 179 702 7790 |
| Eligibility and Benefits /Cigna Cost of Care Estimator | Wednesday, June 9, 2021 | 11:00 | 60 min | 179 319 4586 |
| EFT Enrollment, Online Remittance, and Claim Status Inquiry | Wednesday, June 16, 2021 | 11:00 | 60 min | 179 225 1773 |
| Online Appeal and Claim Reconsideration | Monday, June 21, 2021 | 11:00 | 60 min | 179 162 7760 |
| Website Access Manager Training | Monday, June 28, 2021 | 11:00 | 60 min | 179 940 8512 |
House Passes Prior Auth, ImmTrac2 Improvement
Haters of preauthorization burdens – and if you’re reading this, chances are you’re among them – will celebrate the House’s passage of House Bill 3459 by Rep. Greg Bonnen, MD (R-Friendswood). The bill attacks the plague of prior authorization requirements in two major ways.
First, for certain services, if a physician earns insurer approval on 80% of preauthorization requests for the service in one calendar year, the doctor will be exempt from preauthorization for that service in the next calendar year. HB 3459 would allow physicians to gain those exemptions on an every-other-year cycle
E&M Coding in 2021
Now is the time to take a few minutes to assess your coding.
- If you are coding close to your specialty’s bell curve and if your documentation supports your coding, take a deep breath. If you find you are an outlier, don’t panic. Time is on your side.
- Under-coders of the world, look to increase your coding. Your documentation likely supports a higher code. Over-coders, make sure your documentation supports your higher coding.
- You are at higher risk for an audit, and your best defense will be solid documentation
Are you curious to see how you are doing? Follow this link to “Physicians Practice” article:
E&M Coding in 2021: Four Questions, Four Answers
Physicians Practice
COVID-19 Coverage Assistance Fund (CAF)
MGMA Washington Connection May 6, 2021
This week, the HHS Health Resources and Services Administration (HRSA) announced the creation of the COVID-19 Coverage Assistance Fund (CAF). This new program will reimburse providers the cost of administering COVID-19 vaccines to patients specifically enrolled in certain short-term, limited duration and benefit health plans that either do not cover vaccinations or cover them with patient cost-sharing. Providers can request claims reimbursement electronically through the CAF Portal and will be reimbursed at the national Medicare rate for vaccine administration, and for patient charges related to COVID-19 vaccination, including co-payments, deductibles, and co-insurance for vaccine administration.
As a reminder to those practices that have received more than $10,000 from the Provider Relief Fund (PRF), registration is now open for the PRF Reporting Portal. According to HRSA, the portal is only open for registration. MGMA will update members once the portal is open for reporting.
Re: Cigna MA Referrals
This is a cut and paste from:
(Revised 04/26/21) The current Public Health Emergency (PHE) period has been extended through 07/20/2021. https://www.phe.gov/emergency/news/healthactions/phe/Pages/COVID-15April2021.aspx
Referral Requirements
In-Network Providers: Referral requirements (if required by customer’s benefit plan) are waived for in-network provider services through 07/20/2021.
Out of Network Providers: Referral requirements (if required by customer’s benefit plan) are waived for out-of-network provider services through 07/20/2021.
Cigna MA Referral Requirements
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