Tag: Eligibility and Benefits
BCBS Pharmacy Qtrly Updates for January 2026
Pharmacy Program Quarterly Update Changes Effective Jan. 1, 2026 – Part 1
HealthSpring Rollout
■ Important Updates for Physician Offices-New Plans Coming in 2026
New benefit plans under the HealthSpring name will roll out January 2026. For now, you can find articles about these changes on: MedicareProviders.Cigna.com …and in the Provider Newsroom.
■ Claims Contact Information
Jim Denman will no longer handle claims.
For more information, please call POET
■ Goodbye HSConnect – Hello Availity Essentials
Cigna MA has partnered with Availity Essentials for enhanced online tools. HSConnect and Cigna for HCP are no longer needed.
■ Verify eligibility & benefits
■ Verify primary care provider
■ View customer ID cards
■ View maximum-out-of-pocket amounts
■ Submit professional & institutional claims
■ Check claim status
■ View remittance advice
■ Access Cigna MA links (including prior authorizations & resources) via the Payer Space page
NOW YOU KNOW
Every business, especially a medical practice, needs to run like a well-oiled machine
Just as oil prevents an engine from drying out and freezing up, your medical practice must have a well-developed denial management program in place. This is the first proactive step.
Cigna Digital Solutions Update 11/1/2023
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Beginning October 31, 2023, when you verify eligibility for patients with a third-party administrator (TPA) plan, the electronic data interchange (EDI) 271 transaction will indicate whether they are covered or not covered using information from Cigna Healthcare, as well as the TPA. It will also provide the TPA name and telephone number to confirm further eligibility or benefit information. What are TPA plans? How do I determine if my patient has a TPA plan? Patients with a TPA plan will have “Shared Administration” (or the letter “S”) at the bottom right of their TPA ID card (see the sample below). This designates that Cigna Healthcare shares the administration of the plan with a TPA. The ID card also includes the TPA phone number to call for eligibility and benefits information. |
When the PHE Expires, What then?
How to Reverify Patients’ Medicaid Eligibility
When the Public Health Emergency Ends
With the federal public health emergency (PHE) slated to expire at the end of 2021, millions of Medicaid patients across the U.S. are at risk of losing their coverage. Texas physicians should prepare by scheduling services as soon as possible for such patients and evaluating the financial impact of potential increases in uncompensated care. They also should expect to reverify patients’ Medicaid eligibility when the PHE expires.
Physicians can reverify patients’ eligibility electronically through the Texas Medicaid & Healthcare Partnership (TMHP) Electronic Data Interchange, TexMedConnect, or the Medicaid Client Portal. They can also call the TMHP Automated Inquiry System at (800) 925-9126.
HSConnect, MHK Provider Portal Updated FAQ 11/23/2020
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UHC Provider Resources Regarding the “Link” Portal. Received by POET on 7/1/2020
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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.
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