A pair of big wins capped a successful past week for medicine, as the Texas House of Representatives on Friday afternoon signed off on both curbing the impositions of prior authorization and updating the state’s immunization registry.
Tag: Prior Authorization
Humana Covid-19 Administrative Update 9/1/2021
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Humana’s Covid-19 Response
An important message regarding
Humana’s COVID-19 response:
ADMINISTRATIVE UPDATE Sept. 1, 2021
Humana is suspending authorization requirements for skilled nursing facilities (SNFs) and
long-term acute care (LTAC) for Medicare Advantage and commercial members discharging
from hospitals in the state of Texas through Oct. 1, 2021.
Important details:
- Authorization suspension, as outlined herein, will continue through Oct. 1, 2021.
- This suspension applies to participating/in-network providers only.
- Please provide notification of admission within 24 hours to allow us to track our members’ progress. You will receive
an approval when you submit the notification. - No other services requiring prior authorization are included in this suspension.
UHC Network Bulletin Overview 8/2021
Your NOTICE of protocol
and policy changes
from UnitedHealthcare
Medical policy updates: August 2021
This month, you’ll find updates for Medicaid, Medicare, Exchange and commercial plans.
Prior authorization and notification requirement updates
We’re making changes to certain advance notification and prior authorization requirements that are available for you in the 2021 Summary of Changes.
Reimbursement policy updates: August 2021
This month, you’ll find updates for Medicaid and commercial plans.
Specialty Medical Injectable Drug program updates: August 2021
See the latest updates to requirements for Specialty Medical Injectible Drugs for UnitedHealthcare members.
Prior authorization code updates for commercial plans
Effective Nov. 1, 2021, we are adding new codes to the prior authorization list for UnitedHealthcare commercial plans including All Savers, River Valley, Neighborhood Health Partnership, UnitedHealthcare West, MidAtlantic Health Plans
Step Therapy Requirement
Cigna Medicare Advantatge
The goal of step therapy is to help achieve lower drug prices while maintaining access to drugs for patients.
Certain Part B drugs that currently require precertification will also require step therapy.
The list of drugs that require step therapy can change throughout the plan year.
Cigna MA
Cigna Updates
Cigna is pleased to announce we are expanding our Musculoskeletal and Pain Management Program to include select Cigna Medicare Advantage customers.
Beginning June 1, 2021, precertification requests for affected services, including major joint surgery services related to the hip, knee, and shoulder and interventional pain management procedures must be submitted to eviCore instead of Cigna.
CIGNA MEDICARE ADVANTAGE PRIOR AUTHORIZATION PROGRAM – ORIENTATION SESSION SCHEDULE.
Cigna Medicare Advantage has partnered with eviCore healthcare to provide patients with access to high quality, medically appropriate care that is consistent with evidence-based treatment guidelines.
The following procedures will require prior authorization for patients covered by Cigna Medicare Advantage
- Major Joint Services (Hip, Knee, Shoulder)
- Interventional Pain Management Procedures
eviCore healthcare will be leading online orientation sessions designed to assist you and your staff with the new program. For times and how to register click here.
Step Therapy Required for Part B Drugs and Biologics, Revised 2/24/21
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Cigna Medicare Advantage Prior Authorization Program – Orientation Session Schedule
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House Passes Prior Auth, ImmTrac2 Improvement
Haters of preauthorization burdens – and if you’re reading this, chances are you’re among them – will celebrate the House’s passage of House Bill 3459 by Rep. Greg Bonnen, MD (R-Friendswood). The bill attacks the plague of prior authorization requirements in two major ways.
First, for certain services, if a physician earns insurer approval on 80% of preauthorization requests for the service in one calendar year, the doctor will be exempt from preauthorization for that service in the next calendar year. HB 3459 would allow physicians to gain those exemptions on an every-other-year cycle
COVID-19 news from UnitedHealthcare, April 20th, 2021
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PHE Extended
HHS Secretary Xavier Becerra has renewed the public health emergency (PHE) for COVID-19 effective April 21, 2021. This extension will effectively continue all telehealth waivers and other flexibilities pursuant to this determination. As with previous determinations, the renewed PHE will terminate 90 days after its effective date on Tuesday, July 20, 2021, unless it is further extended. The Biden administration has previously indicated that it intends to continue extending the COVID-19 PHE at least for the remainder of 2021.
MGMA ~ Drew Voytal
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