Inportant Information from Aetna OfficeLink Updates 3/1/2020
Changes and Updates include:
- Aetna’s National Pre-certification List, effective 7/1/2020
- Updates to Aetna’s Commercial Drug List, effective 7/1/2020
- Availity the will be Aetna’s sole Provider Portal, effective 4/30/2020
- Individual Service Codes and Service Grouping Updates, effective 6/1/2020
- Updates for In-Office Surgical Pathology Codes, effective 6/1/2020
- Updates to Drug test Thresholds, Billable Service, Notification for Acute Rehabilitation and Skilled Nursing Facilities and New Claim Edits, etc.
Heads UP – Last Day 3/31/2020
HEADS UP!!
Regarding Cigna MA:
Last day to submit new or correct 360’s for 2019 is March 31, 2020.
Behavioral Health Program Changes for BCBS Effective 6/1/2020
Behavioral Health Program Changes for Some Provider Networks (Corrected)
Starting June 1, 2020, Blue Cross and Blue Shield of Texas (BCBSTX) will administer behavioral health benefits for members enrolled in our Blue EssentialsSM, Blue Essentials AccessSM, Blue PremierSM and Blue Premier AccessSM provider networks. Magellan Healthcare® will no longer administer behavioral health benefits for these members.
Please forgive us for a double post. The original letter from BCBS (posted 2/27/20) left out HealthSelect. To read the corrected article please follow this link.
FYI – Well Care
Many of you are receiving contracts from WellCare for Medicare Advantage etc. WellCare has recently been acquired by Centene.
Centene also owns Superior. POET has a contract with Superior presently for Medicaid only. However, we are working on other products with them also.
Reporting System Makes Documenting PMP Checks Easy.
By David Doolittle, TMA
As you probably already know, beginning March 1, you’ll be required to check the Texas Prescription Monitoring Program, known as PMP Aware, any time you prescribe opioids, benzodiazepines, barbiturates, or carisoprodol.
BCBS Speaks on the Importance of Checking Eligibility and Benefits
As a reminder, it is important to check eligibility and benefits before rendering services. This step will help you determine if benefit prior authorization is required for a member. For additional information, such as definitions and links to helpful resources, refer to the Eligibility and Benefits section on BCBSTX’s provider website.
Please note that verification of eligibility and benefits, and/or the fact that a service or treatment has been preauthorized or predetermined for benefits is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date services were rendered. If you have questions, contact the number on the member’s ID card.
Availity is a trademark of Availity, L.L.C., a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX.BCBSTX makes no endorsement, representations or warranties regarding any products or services offered by Availity, Aerial or Medecision. The vendors are solely responsible for the products or services they offer. If you have any questions regarding any of the products or services they offer, you should contact the vendor(s) directly.
Blue Cross Blue Shield of TX will Manage all Prior Authorizations for HealthSelect, Effective March 1, 2020
There are important changes to the prior authorization requirements for the HealthSelect of Texas and Consumer Directed HealthSelect plans administered by BCBSTX. The list of services requiring prior authorization has not changed; however, beginning March 1, 2020, prior authorizations for services previously managed by eviCore healthcare® will now be managed through BCBSTX.
For more information visit the BCBS file.
Cigna MA PCP E-Newsletter
Topics this month include:
- American Heart Month
- Stars Update – HEDIS MRR & HOS
- CAHPS Corner – CAHPS survey
- Valuable Insights – Annual Wellness Visits
Cigna MA Monthly Lunch and Learn Webinars
CareAllies Coding Team will be hosting MONTHLY Lunch and Learn Webinars.
On Friday, March 20th from 12:00 PM -1:00 PM (CT) via WebEx the agenda will be:
• e-cigarette, or vaping, product use associated lung injury (EVALI)
• New IDC-10 code for vape related injury
• What do your members think of you?
BCBSTX Opt in/out – oops
In case you do not realize it, POET works hard to get information out to you as quickly as possible. In our rush to get the March 1, 2020 updated fee schedule to you – we left out the “Opt in/out” form!
We are emailing the forms to you today! If you do not receive one please notify us!
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