Check out HealthSpring E-News:

Topics this month include:

• Social Determinants of Health (SDOH) Spotlight – Isolating & Distancing
• Low Income Subsidy (LIS) Overview
• COVID-19 Resources
• CAHPS Corner – Health Outcome Survey (HOS)

Two dates left !

To view the slide decks:

• Introduction to TRS – Active Care
• TRS-Aim Provider Training for Prefixs T2U and T2S

For Cigna MA Providers.

1.    Go to medicareproviders.cigna.com

2.    Scroll down slightly and click on “Log in to HSConnect Provider Portal” (in green box)

3.    Click on “Need an Account? Click here.”

4.    If prompted, enter one of your provider’s individual NPI under “ID” and click “Validate Provider”.

5.    Then populate the fields as needed. The staff member requesting can be the “requestor”. Section 2 should list all providers and their associated NPI #s under the group. Section 3 would be the new user’s (or users’) first & last name(s) and corresponding email address(es).

Once submitted, Cigna Medicare Provider Relations team will review for read-only access or full access (with the added ability to submit referrals and pre-certifications). They may need to reach out to you to confirm which access is needed for each user.

Introduction of TRS-ActiveCare and Prior Authorization Expansion to AIM Specialty Health^®

Webinar Sessions

The BCBSTX Network Management Department will be holding webinar training sessions to review the following updates that are effective Sept. 1, 2020.

• Implementation of the Teacher Retirement System of Texas (TRS) participants benefit plan for TRS-ActiveCare.
• Prior authorization for the following outpatient services through AIM Specialty Health (AIM) for certain participants:
  • Advanced Imaging
  • Cardiology
  • Sleep Medicine
  • Joint and Spine Surgery
  • Pain Management
  • Radiation Therapy
  • Genetic Testing Services

Provider Webinar Training Dates

Training sessions are being offered on the following dates and times:

1. Select the link of the session you would like to attend.
2. Complete the registration. 
3. Check for confirmation email with instructions on how to join.

Space for the online training is limited.  If you received a notice that the Webinar you chose is full, please choose another option.

Thursday, August 13, 2020 3:00 pm | Central Daylight Time

Wednesday, August 19, 2020 1:00 pm | Central Daylight Time

Wednesday, August 26, 2020 10:00 am | Central Daylight Time

To view please follow this link.

August 4th – UPDATE ON PHYSICIANS BEING LOADED FROM BCBSTX BELOW:

“I’m working on getting the providers loaded asap.  I don’t know exactly when they will be loaded but I have requested them to be loaded as urgent and will notify you as soon as that’s done so that members can select their Primary Care Physicians.”

The following memo is for POET physicians participating in POET Blue Essentials contract with BCBSTX. Bottom line is if you do not wish to see ANY Blue Essentials member please contact POET. Otherwise you are now completely in the Blue Essentials product (unless there are carved out benefit plans. )

As you may be aware TRS will have an option of Blue Choice or Blue Essentials as of September 1, 2020.

Currently our Blue Essentials agreement only allows for ERS through the definition of Member.

To add TRS and other members, the definition of Member has been changed to:

“Blue Essentials Member (“Member”) means an individual who is eligible to receive Covered Services under a Health Plan that utilizes the Blue Essentials HMO Network. “

This means you will be in network possibly (always check benefits) for ANY patient with Blue Essentials.

If you do not wish to participate in the agreement with this change, please contact POET to request a “opt out” form to sign.

HOW TO LEARN MORE:

BCBSTX is offering webinars to help educate you and your staff about Blue Essentials.  See the below link for more information.

Link to BCBSTX article: https://www.bcbstx.com/provider/providersearch.html?keyword=TRS&state=tx&portal=&collectionType=tx_prod_provider&x=10&y=4

As always if you have questions please feel free to contact POET.

UPDATE: BCBSTX has sent the following reply to POET asking when physicians would show up in website as in network:

“To answer your questions providers can be loaded into the system prior to the effective date; however, they will not be visible for members select on the website until the date the contract takes effect.”

The Texas Chapter of MGMA has announced it’s annual meeting will be virtual. The price for Members and Non- Members ($99) are the same.

The 2020 Annual Meeting is going Digital! 

September 8-11, 2020 

As a precaution and in consideration for the safety of our members and vendors the TMGMA Board has decided to hold a virtual meeting this year.

Topics Include:

• Best Practices for Medical Group Managers & the Pandemic
• Active Shooter Training: Stop the Bleed
• Cybersecurity Panel
• How to Avoid Burnout
• Commercial Payor re: Denials/Appeals Process for Prior Authorization and/or Contract Negotiations for In Network
• Medicare/Medicaid: Coding Updates for 2020
• Prior Authorizations in Texas: Burdens and Policy
• Status of Rural Health
• TMGMA Annual Business Meeting
• Principal Care Management
• MGMA Legislative UpdateTexas Bills: Prior Authorization, Claim Denials, Sales Tax Bills, Surprise Billing

Registration Information

Before August 15, 2020
*ALL PRICING BELOW WILL INCREASE $100 AFTER 08/15/20

Members
Active – $99
Affiliate – $99
Faculty – $99
Student – $99

Non-Members
Non-Member – $99
Affiliate Non-Member – $99

HHS has extended the PHE for another 90 days as indicated in the announcement on this link and below. https://www.phe.gov/emergency/news/healthactions/phe/Pages/covid19-23June2020.aspx

Renewal of Determination That A Public Health Emergency Exists

As a result of the continued consequences of Coronavirus Disease 2019 (COVID-19) pandemic, on this date and after consultation with public health officials as necessary, I, Alex M. Azar II, Secretary of Health and Human Services, pursuant to the authority vested in me under section 319 of the Public Health Service Act, do hereby renew, effective July 25, 2020, my January 31, 2020, determination that I previously renewed on April 21, 2020, that a public health emergency exists and has existed since January 27, 2020, nationwide.

From MGMA 7/22/2020

FROM MGMA

HHS released an overview of future reporting requirements for providers that received payments under the Provider Relief Fund. HHS outlined the timing of future reporting requirements for providers that receive payments that exceed $10,000 in the aggregate from any Provider Relief Fund distribution (i.e., any payment under the $50 billion general distribution; Medicaid distribution; or a targeted distribution). The overview released on July 20 does not indicate whether providers that received $10,000 or less will be subject to any reporting obligations, and does not provide detail as to the form or content of reports. However, the following timeline is provided:

• August 17, 2020: Detailed instructions will be available by this date
• October 1, 2020: Reporting system comes available
• February 15, 2021: Report due
• July 31, 2021: Second report due for those who expended funds in 2021

MGMA will continue to monitor this issue and update the community as soon as detailed instructions for reporting become available.

Drew Voytal
Associate Director
MGMA Government Affairs
Washington, DC

by Joey Berlin, July 17, 2020

The Texas Medical Association has updated its white paper on Texas’ law for settling out-of-network billing disputes involving state-regulated health plans.

The eight-page white paper, first released last December, covers the ins and outs of Senate Bill 1264, the 2019 legislation now in effect. SB 1264 took patients out of the middle of surprise-billing disputes between certain out-of-network physicians and state-regulated health plans, allowing them to settle those disputes through an arbitration process similar to the one used to settle salary disputes in Major League Baseball.

The white paper update comes after the Texas Department of Insurance  adopted a final rule touching on exceptions to SB 1264’s general ban on balance billing for out-of-network services the law covers. SB 1264 prohibits balance billing except in certain circumstances, which include required notice and disclosure.

The newly amended rules include these changes that TMA requested:

• Legal representatives or guardians of a patient may be the people to agree to an out-of-network physician’s required notice and disclosure of a potential balance bill;
• A physician may delegate the record-keeping of that notice and disclosure statement by allowing a practitioner’s “agent or assignee” to maintain a copy of the statement. Also, the statement only has to be maintained if the practitioner provides the medical service or supply at issue and sends a balance bill.

You can read the complete adopted rule on page 4,204 of the June 19 Texas Register.

To view the TMA updated white paper on Ink, follow this link.