HSConnect
If you are experiencing an issue with HSConnect, Please Read.
From HealthSpring regarding referrals: Our apologies for the inconvenience and confusion, but this is a known issue within the HSConnect/MHK platform. All of our specialists are showing non-participating in HSC/MHK as of 2021 for some reason, even with a correct NPI of a participating specialist. It is currently being researched and examined on this end. In the meantime, my understanding is that the PCP can still submit the referral despite the notification – it’s just causing some confusion to see a par provider listed as non-par. We’re hoping to rectify the issue as soon as possible as to limit the disruption for our physician offices and members.
If you are having an issue checking eligibility, you may do so via automated phone system:
1-800-230-6138, option 1
To request HSConnect support (Please take screen shots if possible) Email:[email protected]
UHC Claim Reconsideration, Appeals Process 1/1/2021
2021 UnitedHealthcare Administrative Guide
“You must submit both your reconsideration and appeal to us within 12 months (or as required by law or your Agreement), from the date of the EOB or PRA. The 2-step process, as outlined below, allows for a total of 12 months for timely submission for both steps (Step 1: Reconsideration and Step 2: Appeals).”
To view the full Claim Reconsideration and Appeal process, forms, instructions, and etc. for UHC follow this LINK.
Texas Health Plans Adopt Various Temporary Deadlines for CoVid-19
The Texas Medical Association has been tracking health plans’ various waivers throughout the COVID-19 pandemic, as well as state and federal deadlines and program extensions.
Find more information, tools, and resources check out the full article. Located in InK file, “The Business End” or just click on the highlighted text.
POET Holiday Hours
POET will be closed beginning December 23rd and re-open December 28th.
The Staff at POET wishes you all a very Merry Christmas and pray for good health to be with us all.
Stay safe.
Physician Directory Updated 12/17/2020
To View the Updated Directory
2021 E/M Coding, Billing, and Auditing Toolkit 12/9/20
Getting paid for some of the most routine outpatient office visits becomes a new challenge on January 1st, when guideline and code descriptor changes for E/M services — previously announced by
the American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS) – take effect.
Visit the Ink file called “The Business End” to access “MGMA’s 2021 E/M Coding, Billing and Auditing Toolkit”
- Outpatient Office Visit E-M Codes, Preparing for 2021 – On Demand Webinar
- 2021 Medical Decision Making for Outpatient E-M Codes
- Preparing Your Practice for 2021 E-M Changes
- Medical Decision Making for Outpatient E-M Codes
- 2021 Medicare Physician E-M Fee Schedule Analyzer Tool (Non-facility).
- MGMA-2021-Final-Rule-EM-Fee-Schedule-Analyzer-Tool
- 2021 Medicare Physician Fee Schedule (PFS) Tool (Non-Facility)
- MGMA-2021-Final-Fee-Schedule-NonFacility-V1
- 2021 Medicare Physician Fee Schedule (PFS) Tool (Facility)
- MGMA-2021-Final-Fee-Schedule-Facility-V1
- 2021 E-M Outpatient Office Visit Codes FAQ
- 2021 E-M Audit Worksheet
- 2021-EM-Audit-Worksheet
- 2021 E-M Coding Quick Reference
- 2021-EM-Quick-Reference
I Am Going to File A Complaint!!!!
Now you do! POET has scoured the Universe. We have compiled information on how to file a complaint, with just about anybody you might want to file a compliant with. The OIG, TDI, BBB, CMS, TRS, ERS, Texas School Board, State Employees, Federal Employees, CHIPS, Self Funded Employee Groups, TMHP, Tricare, the Attorney General… Check it out, downloaded it, get out your pen….
MGMA 2021 Medicare Outlook
MGMA hosted their “2021 Medicare Update” yesterday Dec. 10th. That presentation has been recorded and is available for MGMA members on their website.
For your convenience the slide deck has been place in POET InK’s files. To view follow this path.
Aetna OfficeLink Updates Published 12/1/2020
For new and updated information on:
- Changes to Aetna’s National Precertification List (NPL)
- Surgical procedures performed in the ER, modifier 54, rate change
- Beginning March 1, 2021 you may see new claim edits. These will be part of Aetna’s 3rd Party Claim and Code Review Program.
- Individual Service Codes are being assigned to Service Groups (a lot of changes are coming)
- Changes in Commercial and Medicare Drug list
- Changes in Prior Authorization Requirements
TMA’s Reimbursement Specialist Want You to Know
About These Items That Are Listed in the UnitedHealthCare December Bulletin:
- Starting January 1, UHC will follow the revised 2021 E&M coding and guideline changes for the AMA and CMS.
- January 1, for Medicare Advantage plans, UHC will expand prior authorization requirements and site-of-service medical necessity reviews.
- And, UHC has delayed implementation of its Laboratory Test Registry protocol
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