Tag: Reimbursement Policies
The First Quarter 2022 issue of Cigna Network News is now available
Check out these pages:
4. Preventive Care Services Policy Updates
5. Reimbursement Policy Updates
7. Precert Updates (click here to view the Master Precert List)
8. Webinar Schedule for staff training.
18. 2022 Cigna MA plan highlights (and card sample)
25. How to use Z Codes
34. How to contact Cigna
United Healthcare Latest Updates
One Stop Shopping.
Click Below to get the latest updates on:
Policy and protocol
Reimbursement policy
Prior Authorization
And More
UHC Network News Brief 10/1/2021
Catch All the UHC UPDATES
October 2021 Policy and Protocol Updated Overview
- Medical policy update: October 2021
- Pharmacy Updates
- Prior Authorization and Notification Requirement Updates and 2021 Summary of Changes
- Reimbursement Policy Updates: October 2021
- Specialty Medical Injectable Drug Program Updates: October 2021
Your Notice of Protocol and Policy Changes from UHC
- Medical Policy Updates Effective 9/1
- Prior Authorization and Notification Requirement Changes
- Reimbursement Policy Updates
- And More
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
Prior Auth. Time Frames
Several commercial payers have resumed prior authorization time frames and requirements that had been suspended because of the COVID-19 emergency, while others will continue to approve prior auth requests or suspend them for at least part of the year.
Below is an overview of some payers’ COVID-19 prior authorization policies as of April 2021: Click on the Links for more detail.
Blue Cross and Blue Shield of Texas ended approvals on services with existing prior authorizations on Dec. 31, 2020.
Aetna is approving prior authorization requests for commercial and Medicare Advantage members until the end of the plan year. “Authorization may be extended beyond the plan year, for a period of six months, if continued eligibility can be confirmed.”
Cigna resumed standard prior authorization time frames and requirements beginning April 1, 2021.
Humana resumed standard prior authorization time frames and requirements beginning April 1, 2021
UnitedHealthcare will not require prior authorization for most services through the national public health emergency period, currently scheduled to end April 20, 2021. Exceptions include medical and behavioral health services, post-acute care admissions, site of service reviews, and transfers to new providers. Prior authorizations for medical and behavioral health were not subject to extension on or after April 10, 2020.
Article written by Ellen Terry : https://www.texmed.org/TexasMedicineDetail.aspx?id=53502&utm_source=Informz&utm_medium=Email&utm_campaign=TMT&_zs=cPrdA1&_zl=CvCF6
UHC Cuts NPP Payments
A recent UnitedHealthcare (UHC) policy will not only cut payments by 15% to physicians who employ nonphysician providers (NPPs), but also cause needless confusion in the billing process.
That’s according to a letter the Texas Medical Association wrote to the insurer expressing concern over the policy, which took effect March 1.
UHC in December announced a policy that requires advanced practice nurses and physician assistants to bill for their services using their own National Provider Identifier (NPI) when they have not met “incident-to” billing requirements.
Payments billed using an NPP’s NPI number are typically 85% of the physician’s rate.
Despite medicine’s concerns, UHC further revised its policy in March to require that services provided by NPPs will be eligible for incident-to consideration – and thus the full 100% payment – only if the NPPs do not have their own NPI number.
That policy is scheduled to take effect May 1.
“It is TMA’s policy on physician assistants and allied health personnel that reimbursement for services performed by a physician assistant should be made directly to the responsible physician,” TMA wrote in a letter in February. “While greater use of nonphysician personnel can improve the system, responsibility for care must be clearly defined if various personnel are to work together effectively to provide high quality services for the patient.”
TMA also urged UHC to provide further education to physicians and NPPs on proper incident-to billing.
“As part of this effort, UHC should make it clear that physicians can continue to utilize advanced practice nurses and physician assistants under proper incident-to billing arrangements, even if the advanced practice nurse or physician assistant has their own NPI,” the letter says.
TMA is setting up a meeting with UHC officials to discuss the policy, and will report on any updates in Texas Medicine Today.
For more information on incident-to billing requirements, TMA has published a questions and answers document and billing guidelines.
Regarding the Ever Changing Telemedicine Guidelines.
KZA Telehealth Solutions Center
An up-to-date, comprehensive resource regarding
the ever-changing telemedicine guidelines.
KarenZupko and Associates, Inc. has been around for a long time.
They have shared a link to their website for updates to telehealth on the MGMA Community.
Please note, they update materials as changes are made by CMS.
So check back often!
There is a very nice chart on Payor Telehealth Policies and
lots more.
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