Texas Medical Association (TMA) – Page 7

HAVING UHC CLAIMS ISSUES?

If You Are Having UHC OON

Claims Issues,

Please Read This!

POET is working with the TMA regarding UHC OON issues. They have confirmed the following:

If you are billing with a GROUP TIN:

You will not utilize the group NPI# in box 33a – if you do, it will process OON. Only the individual physician’s NPI# should be listed here since your physicians has an individual contract with UHC, not a group contract.

For those claims processing OON, if timely filing limits have not passed you should file corrected claims with the individual NPI in box 33a.

When verifying whether a physician is in or out of network, you should not provide the group NPI#.

This only reflects physicians who are in the POET All Products contract. If you have a direct, POET is unable to direct you in this matter.

Vaccine Documentation Can’t be Required for Medical Treatment

The Texas Health and Human Services Commission (HHSC) is notifying practitioners who see Medicaid patients that those patients can’t be required to provide documentation of their COVID-19 vaccination status as a condition of receiving services under Texas Medicaid.

The agency’s Sept. 17 announcement references Gov. Greg Abbott’s Aug. 25 executive order, which bars “[a]ny public or private entity that is receiving or will receive public funds through any means” from requiring COVID-19 vaccination documentation to receive services.

TMA “Ask the Expert” Virtual Series

Today’s “Ask the Expert” subject “How to Delegate to Non-physician Practioners” will be available On-Demand in a couple weeks. The link to access the recording will be www.texmed.org/asktheexpert.

UPCOMING TOPICS

TX Prescription Monitoring Program

TX Prescription Monitoring Program, No Longer a Freebie!!

When Texas started requiring that physicians check the state’s prescription monitoring program (PMP), the state appropriated funds to cover the licensing fee for the first two years. Effective Sept. 1, however, that fee is no longer covered by the state, and Appriss, the state’s PMP vendor, has begun billing physicians for the annual PMP licensing fee.

TMA is exploring options with the governor’s office, Texas State Board of Pharmacy, and Appriss to tap into the opioid settlement funds to defray the cost of the PMP. However, it does not appear that funding will be available prior to Sept. 1, TMA officials say.

The association has reached out to Appriss to understand the pricing structure on the invoice that physicians are receiving. Appriss has indicated the following options for physicians:

Cost for the basic service – integrated access to the PMP through the physician’s electronic health record– is $50 per prescriber per year. This is access to controlled substance prescription data only.
Cost for the optional NarxCare graphic interface and Appriss analytics is an additional $250 per prescriber per year.
Always available at no cost is manual web access to the PMP through the Texas Board of Pharmacy via PMP Aware.

Physician groups may check with Appriss to see if they are eligible for reduced pricing per prescriber.

At TMA’s urging, Appriss is working on additional communications to physicians that more clearly explain the options and associated fees.

If you choose not to renew with Appriss, access to the PMP will no longer be accessible through your EHR within your workflow. It will still be available for free when you log in to the state’s system, PMP Aware, to check a patient’s prescribing history as required by law before prescribing opioids, benzodiazepines, barbiturates, and carisoprodol.

Questions about prescribing and the PMP program may be directed to TMA’s Health Information Technology Department by calling (800) 880-5720 or by email. Also check out TMA’s PMP resource page.

Nonphysician Practitioners and Scope of Practice

TMA Ask the Expert Virtual Event

August 17th at 1 PM

How to Delegate to Nonphysician Practitioners.

Nonphysician Practitioners and Scope of Practice, a TMA Ask the Expert virtual event, will teach participants how to comply with state laws and regulations on delegating and supervising prescriptive authority. Join Carra Benson, TMA manager of practice management and reimbursement services; Dan Finch, TMA vice president of advocacy; and Julian Rivera, health law partner at Husch Blackwell, on Aug. 17 at noon CT.