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

View this newsletter.

 

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

Revised UnitedHealthcare E&M, Prior Auth Procedures to Take Effect Jan. 1. by Ellen Terry, Texmed.org

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