Cigna Healthcare to launch digital Provider Newsroom in 2024

In early 2024, Cigna Healthcare will launch a web-based Provider Newsroom for health care providers. It will offer intuitive navigation with 24/7 access to timely updates that are important to your practice.

The newsroom will give you a single source of news for many of our lines of business, including commercial medical, Medicare Advantage, and behavioral health. In addition, it will replace existing newsletters for each of these areas, including Network News, Network Insider, and Transformations, respectively.

In the newsroom, you will find up-to-date information on a variety of topics impacting your practice, such as:

• Policy updates
• Health plan and network updates
• Digital tools and trainings
• Industry news
• And more

You will continue to access the Cigna for Health Care Professionals website (CignaforHCP.com) for routine day-to-day business processes, including checking benefits and eligibility, requesting claim reconsideration, and enrolling in and managing electronic funds transfer.

Watch for updates

We will continue to send you emails with additional information about the digital Provider Newsroom, how to access it, when it will launch, and more.

If you have any questions about Cigna Healthcare’s digital Provider Newsroom, please contact me directly anytime.

home state health – behavioral health authorization process changes

BEHAVIORAL HEALTH AUTHORIZATION PROCESS CHANGES

Helping you care for your patient’s behavioral health needs is a top priority

Home State Health supports the timely completion of medical necessity reviews to support high quality outcomes for our members. Providers may submit requests for services through our Secure Provider Portal or fax. To improve the efficiency of the authorization process, we moved to a standardized fax document for authorization requests.

There will be one form for Inpatient Authorization requests and a second for Outpatient Authorizations that support both Behavioral Health as well as Physical Health authorizations. Through use of standardized forms, we reduce the number of separate forms for treatment requests and enhance the flexibility for the providers in the format of their clinical information. Guidelines on the clinical information needed for each behavioral health service type are available on our OTR Completion Tip Sheet.
Our provider website contains the new standardized forms in the Provider Resources section of our website: homestatehealth.com/providers/behavioral-health.

If you have additional questions or need specific support, please see the homestatehealth.com/providers/tools-resources section of our website or call Provider Services: 1-855-694-4663.

PHONE:  Inpatient Authorization requests:  1-855-694-4663
FAX:        Inpatient Authorization fax:  1-833-405-3826

PHONE:  Outpatient Authorization requests:  1-855-694-4663
FAX:        Outpatient Authorization fax:  1-833-405-3827

Anthem Provider Newsletter – Missouri January 2024

This month’s featured articles:

Administrative

• Introducing Paytient: a new interest-free way for your patients to pay for out-of-pocket costs
• Inappropriate primary diagnosis
• CAA: Maintain your online provider directory information
• Important Changes for Active Members of Northrop Grumman Corporation
• Using and billing air ambulance services appropriately

Digital Tools

• Training for digital requests for additional information (Digital RFAI)

Education and Training

• Important information about your Anthem patients’ specialty prescriptions

Medical Policy & Clinical Guidelines | Medicare Advantage

• Clinical Criteriaupdates — August 2023
• Genetic testing code list update

Medical Policy & Clinical Guidelines | Commercial / Medicare Advantage

• Updates to Carelon Medical Benefits Management, Inc. Clinical Appropriateness Guidelines
• Transition to Carelon Medical Benefits Management, Inc. cardiology guidelines

Medical Policy & Clinical Guidelines | Commercial |

• Carelon Medical Benefits Management, Inc. genetic testing CPT^®code list update

Prior Authorization | Commercial |

• Expansion of Carelon Medical Benefits Management, Inc. programs effective April 1, 2024

Prior Authorization | Medicare Advantage |

• Expansion of Carelon Medical Benefits Management, Inc. programs effective April 1, 2024

Dental | Commercial

• January Dental newsletter communications

Pharmacy | Commercial

• Specialty pharmacy updates — January 2024

Quality Management | Medicare Advantage

• Boost annual planned visit rates

Quality Management | Commercial / Medicare Advantage

• HEDIS diabetes documentation
• Annual preventive care visits

Get ready for digital-only Medicaid reconsideration and appeal submissions

Beginning Feb. 1, 2024, claim reconsiderations and medical pre- and post-service appeal submissions must be submitted electronically for UnitedHealthcare Community Plans (Medicaid) in the following states:

• Michigan
• Missouri
• New Jersey
• North Carolina
• Tennessee
• Washington
• Wisconsin

The first link will direct you to the general announcement while the second link contains more detailed informaiton.

Medicaid Digital-Only Submissions

Feb. 1: Reconsideration and appeal submissions going digital-only | UHCprovider.com

The January edition of the Medica Connections is now available for review by opening the attached file.

Jan2024Conn – Final

The following topics are covered in this edition.

General News

• Be aware of possible benefit changes for you Medica patients as there will be updates 01/01/2024. Please verify benefits.

Clinical News

• Medical Policies and clinical guidelines to be updated effective 02/19/2023. The full list of updates can be viewed by following the link on the attachment. You can also call 1-800-458-5512 option 1, option 8, ext 2-2355 to request printed copies.

Pharmacy News

• Medica to add new UM policies for 4 new medical pharmacy drugs effective 03/01/2024-Aphexda, Loqtorzi, Omvoh and Pombiliti.

Network News

• No updates to affect our region

Administrative News

• Provider administrative training webinar for January:  Navigating Provider Resources.  This is scheduled for January 18^th 12:00pm – 1pm CST.  The registration link and additional information can be found on the attachment.

HealthChoice News Update 122223

Featured Articles:

• Modifier 25
• Billing for DOC inmates
• Observation stays
• Submitting partial hospitalization and intensive outpatient program certification requests

Please follow the link below for more information related to the change to UHC for FedEx employees that choose that Option.

Reminder FedEx Employees may access UHC

Cigna – Reimbursement Policy Update – Revenue codes 270-279 billed without a procedure code UPDATE

We recently sent a letter informing you about a reimbursement policy update that would administratively deny revenue codes 249-259 and 637 when billed without a procedure code. We have reevaluated this reimbursement policy change, which affects its implementation.

What this means to you
• The previously communicated update to the Revenue Code Billing Requirements (R41)
reimbursement policy is no longer effective for claims submitted. with revenue codes 249-259 and 637 without a procedure code.
• Claims you may have submitted for dates of service on or after September 17, 2023 that were denied as a result of this policy update will be automatically reprocessed. You do not need to take any action.

If we decide to proceed with this policy update, we will communicate _a new imp!ementation date and additional details. at a later time.

As a First Health provider, you are considered an in-network provider for Curative members.

Curative, a health plan administrator with $0 deductible, $0 copay, and $0 out-of-pocket costs for all in-network care, is now accessing the First Health Network*. Curative has recently expanded its services to include employer groups that will access the network, and our goal is to ensure that there is no question about your network participation and no disruption in care.

Please make sure that your scheduling and front office staff know about your First Health participation so that Curative members can access your services with their in-network benefit. If you have any questions about your network status, please call First Health at 1-800-226-5116, First Choice of the Midwest at 1-888-246-9949, and Cofinity at 1-800-831-1166.

Please ensure that you are reviewing the health plan ID card and submitting claims as indicated on the ID card.

To confirm patient eligibility, please visit https: /curative.corn/eligibility. For electronic billing, please use payer ID: CURTV.

For more information, please visit the First Hea!F1 Network provider page at https:// curatlve. com/first health- network.

Questions about Curative’s plan? Reach out to or call provider support at 855-414-1083.  To learn more about Curative, please visit https:/curative.corn.

*Every Curative member qualifies for the $0 deductible, $0 copay for in-network care, and preferred prescriptions by completing a Baseline Visit within 120 days of the plan effective date. See https:/curatlve.corn to learn more.

Arkansas BCBS – Providers News December 2023

This month’s featured articles:

Arkansas Blue Cross and Blue Shield

• Coverage Policy Manual Updates
• DispatchHealth
• Electronic Data Interchange (EDI) Unique Submitter Identification Number No Longer Required for Claims Submission
• Medical Pharmacy Coverage changes
• Medical Records Review Process Improvements
• New Prior Authorization for GLP1 Receptor Agonist Drug Class
• Overpayments: Payer-Identified Overpayments now Available on Availity Essentials Portal
• Paper Claim Reduction
• Please Hold Claims Incurred During the Credentialing Process
• Please Use Availity During Open Enrollment
• Prior Authorization (PA) Intake Methods Changing
• Provider enrollment and re-credentialing
• Medical specialty medications prior authorization update
• Quality of Care (QOC) Complaints
• Metallic Formulary changes effective January 1, 2024
• Standard formulary changes effective January 1, 2024
• Value formulary changes effective January 1, 2024
• USAble MCO and Workers’ Compensation
• Zero-dollar CPT codes

Federal Employee Program

• 2024 FEP Benefit Changes
• Plan-specific updates
• HEDIS Improvement Coding Guide for Practitioners and Coders Prenatal and Postpartum Care Measures
• FEP Reminders

Medicare Advantage

• CMS Requirement for Provider Certification on National Plan and Provider Enumeration System (NPPES)
• CMS Part D Guidance
• HIPAA and HITECH Reminders
• Medicare Advantage Pharmacy Update
• Medicare Part B Step Therapy
• Paper Remittance Advice Changes: Arkansas Blue Medicare
• Reminder on Billing Qualified Medicare Beneficiaries
• Requirements for Medicare Outpatient Observation Notice

Blue & You Fitness Challenge

• 21st Annual Blue & You Fitness Challenge