Arkansas Blue Cross Blue Shield – Providers’ News November 2023

November 17, 2023

Arkansas BCBS – Providers News November 2023

Featured Articles:

  • Prior Authorization (PA) Intake Methods Changing
  • Reminder on Prior Authorization Requirement Changes for 2024
  • Organizational Determination/Benefit Inquiry
  • Prenotifications
  • Billed Codes Reminder
  • FAQs

Cigna – Cigna International Health

November 16, 2023

Cigna International Health is a segment of Cigna Healthcare business that offers solutions to globally mobile individuals and employers with a portion of their workforce that frequently spends extended time overseas. These plans provide a whole health service platform with a personalized, predictable, and simple customer experience that drives affordability of medical plans. As part of a global organization, we have access to health care support in more than 200 countries and territories around the world.

What you need to know

  • Cigna International Health products are supported by our preferred provider organization and Open Access Plus network plans for services rendered in the United States.
  • Coverage for Cigna International Health customers is included in the Cigna Healthcare provider agreement for participating providers in the United States.
  • Participating providers will be reimbursed at the same rate for services provided to international customers as they would for any other Cigna Healthcare customer.

Types of international customers in the United States

  • Returns – Citizens of the United States living abroad. Many of these expatriates and their families will receive routine medical care during annual visits home. In addition, they will often return to the United States for the treatment of serious conditions.
  • InpatriatesForeign nationals who are living and working in the United States.
  • Stay-behinds – Some expatriates leave their families at home in the United States when they go on assignment overseas. These dependents (or “stay-behinds”) have coverage through Cigna International Health.

Cigna International Health eligibility, benefits, and precertification

Providers can verify eligibility, benefits, and precertification requirements for many Cigna International Health customers by visiting the Cigna for Health Care Professionals website (CignaforHCP.com). If the information cannot be located on the website, please call the number on the back of the customer’s insurance ID card.

Cigna International Health claims submission process

Please submit your Uniform Billing claim form or Health Care Financing Administration claim form via an electronic data interchange using the payer ID 62308.

Important note: Contracted providers are required to request a copy of the Cigna International Health ID card and bill Cigna International Health directly. Any missing required information might result in a delay in payment.

Cigna International Health clinical and payment-related appeals process

Please submit your appeals for denied claims or precertification requests using the contact information provided on the explanation of benefits and/or denial letter.

Cigna International Health reconciliation process

  • For issues with Cigna International Health claims please contact the phone number on the back of the members identification card.
    • This will differ from the standard United States customer service and provider services line.
  • For any escalated issues please contact your U.S. Provider Relations representative

VA Community Care Region 3 Overview

November 14, 2023

Through November and mid-December Optum will be offering an overview of the Veteran Affairs Community Care Network for Region 3.  This would include our Arkansas and Oklahoma communities.  Additional details and registration information can be found on the attachment.

Registration_Invite_4Q_2023

Cigna – Explore cultural competency and health equity resources

November 06, 2023

Cultural Resources You Can Use 

As a Cigna Healthcare provider, you have access to our cultural competency and health equity resources that can be used to help you and your staff enhance interactions with culturally diverse patient populations. For your convenience, some of these resources are listed below.

 CultureVision®

This user-friendly online database gives you access to culturally relevant patient care information at no charge.1 CultureVision contains information for nearly 75 ethnic groups, religious groups, and additional cultural communities. Contracted providers can access this database by going to CultureVision.com and using the following login and password:

Login: Cigna Providers

Password: explore12!

For more information, please visit our CultureVision dedicated web page.

Health disparities resources

Access patient resources, feature articles, short videos, and webinars to support you in delivering culturally responsive care to patients who have a greater likelihood of developing certain diseases, such as diabetes and heart disease.

  • Health Disparities web page.
  • African American/Black Health Disparities web page.
  • Hispanic and Latino Health Disparities web page.
  • South Asian Health Disparities web page.

Social determinants of health resources

Language assistance services2

Obtain discounted rates of up to 50 percent for language assistance services – such as telephonic and face-to-face interpretations, as well as for written translations – for eligible patients with Cigna Healthcare coverage. Your office works directly with professional language assistance vendors, with whom we’ve negotiated these savings, to schedule and pay for services.

Cultural competency training

Our eCourses can help you develop cultural competency, learn overall best practices, and gain a deeper understanding of subpopulations in the United States. The eCourses include topics such as:

  • Gender disparities.
  • Diabetes among subpopulations.
  • Cultural agility.
  • Culturally responsive care.

Tool kit: Gender-inclusive language guidelines

This one-page tool kit shares concrete examples of gender-inclusive language, an important aspect of delivering culturally responsive care in alignment with CLAS Standards.4 It will also help you to be compliant with Section 1557 of the Affordable Care Act.

****RESCINSION****KMAP Ordering/Referring NPI vs Performing/Billing NPI

November 03, 2023

KMAP has rescinded this policy that was scheduled to go into effect 11/01/2023.  Based on this policy a claim where the Ordering/Referring NPI is the same as the Performing/Billing NPI would be denied.  This would have an impact on the Kansas Managed Medicaid plans-Sunflower Medicaid, Aetna Better Health and UHC Community Plan-KS.

While this has been rescinded the expectation is that they policy will be put into place at a later date.

 

Medica Connections November 2023

November 03, 2023

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

Medica Connections

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

Clinical News

  • Medical Policies and clinical guidelines to be updated effective 12/18/2023.  You can also call 1-800-458-5512 option 1, option 8, ext 2-2355 to request printed copies

Pharmacy News

  • Medica has retroactively implemented a new preventive drug benefit covering immunizations for RSV.  This is effective 08/15/2023 and covers the adult vaccines Arexvy and Abrysvo and the new antibody injection for infants Beyfortus.
  • Medica to add new UM policies for 4 new medical pharmacy drugs, 12/01/2023

Network News

  • Effective 01/01/2024 Medica will be updating various fee schedules

Administrative News

  • Provider administrative training webinar for October:  Working across Cultures.  The registration link and additional information can be found on the attachment

Anthem Provider Newsletter – November, 2023

November 01, 2023

Anthem Provider Newsletter – Missouri November 2023

This month’s featured articles:

Digital Tools

Education and Training

Administrative

Policy Updates

Reimbursement Policies

Federal Employee Program

Pharmacy

Quality Management | Commercial / Medicare Advantage

 

Cigna Network News – Fourth Quarter 2023

October 25, 2023

Click on the following link to access the current edition of Cigna Network News.

Cigna Network News 4th Quarter 2023

Cigna – HIV pre-exposure prophylaxis services

October 23, 2023

We routinely review our coverage, reimbursement, and administrative policies for potential updates.

As a result of a recent review, we have updated the Preventive Care Services Administrative Policy (A004) to include International Classification of Diseases, 10th Revision (ICD-10) diagnosis code Z29.81: Encounter for human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP).

What this means

Effective for dates of service on or after October 1, 2023, ICD-10 code Z29.81 should be used when submitting claims for encounters for HIV PrEP services.

In accordance with the Affordable Care Act, we will cover these services without a cost share.

 

Additional information

For additional guidance, view the Preventive Care Services Administrative Policy (A004).