Cigna – Coverage Policy Update – Transthoracic Echocardiography Codes 102523

As a result of a recent review, we will update the Transthoracic
Echocardiography in Adults (0510) medical coverage policy to remove
151 International Classification of Diseases, Tenth Revision (ICD-10)
codes and add eight ICD-10 codes.

Denials will affect the claim line only and include medical necessity appeal
rights. This update is effective for dates of service on or after October 25, 2023.

For more information about our policy updates, visit the Cigna for Health Care Professionals website:  (CignaforHCP.com) >Resources> Coverage Policies> Policy Updates .

Cigna Reimbursement Policy Update – Bone Graft Substitutes 102523

As a result of a recent review, we will administratively deny bone graft
substitutes as incidental to a facility’s global surgical fee when billed under
revenue code 278. Denials will affect the claim line only and include
administrative appeal rights.

This update is effective for dates of service on or after October 25, 2023.
We will update the Facility Routine Service, Supplies, and Equipment
(R12) reimbursement policy to reflect this change.

HealthChoice Network News Summer 2023

In this issue

• HealthChoice contracts and applications
• EGID Network Management
• Updating your billing address
• Fee schedule updates
• HealthChoice contact information

Anthem Provider Newsletter – Missouri August 2023

This month’s featured articles:

Featured Articles

• Looking to earn CME credits? Check out the CME Engagement Hub!
• Reminder: Start using the Provider Data Management application now on Availity Essentials — retirement of previous intake channels October 1, 2023

Administrative

• Urinary tract infection tool kits are on the way
• Anthem Blue Cross and Blue Shield appropriate coding helps provide a comprehensive picture of patients’ health and services provided
• Clinical Laboratory Improvement Amendments
• Federal Consolidated Appropriations Act (CAA) Gag Clause
• CAA: Review your online provider directory information regularly

Policy Updates

• Clinical Criteria updates – March 2023
• Updates to Carelon Medical Benefits Management, Inc. Joint Surgery, Small Joint Surgery, and MSK Level of Care
• Expansion of Carelon Medical Benefits Management, Inc. cardiology programs effective October 1, 2023
• Updates to Carelon Medical Benefits Management, Inc. Clinical Appropriateness Guidelines for joint surgery and MSK level of care
• Prior authorization requirement changes effective November 1, 2023
• Technology Assisted Surgical Procedures

Products & Programs

• Specialty pharmacy updates – August 2023
• Specialty pharmacy updates – July 2023
• Pharmacy information available on our provider website
• Medication adherence: Back to the basics
• Why statin therapy is important in your patients with diabetes
• Healthy blood pressure recheck initiative
• Pharmacotherapy Management of COPD Exacerbation (PCE) HEDIS® Measure
• Congenital syphilis is a sentinel health event

Cigna – Reimbursement Policy Update – Hospital in the Home 100123

We will implement a new reimbursement policy, Hospital in the Home (R42), to outline the reimbursement of these services for Centers for Medicare & Medicaid Services-approved hospitals that participate in the Acute Hospital Care at Home program.

• This update is effective for dates of service on or after October 1, 2023, and applies to customers over 18 years of age with Cigna Healthcare commercial and Individual & Family Plans only.
• Precertification is required and the policy is limited to specific conditions.
• Only direct admissions to hospital in the home from the emergency room are eligible.
• A discount off the current contracted inpatient reimbursement rate will be applied to  hospital in the home admissions.
• For additional information, please contact your Cigna Healthcare provider contracting representative.

Cigna Reimbursement Policy Update – Anesthesia 101423

As a result of a recenfreview, we want to make you aware that we will make the following updates effective for dates of service on or after October 14, 2023.

• We will deny the unbundled Current Procedural Terminology (CPT®) code when billed  with one or more of the following anesthesia codes by the same provider on the same day,
• We will reduce reimbursement to four units for anesthesia claims submitted with modifier AD and CPT codes 00100-01999.
• For additional information, call Cigna Healthcare Customer Service at 800.88Cigna
  (882.4462).

Cigna Healthcare strives to informally resolve Medicare Advantage issues raised by providers on initial contact whenever possible. If an issue cannot be resolved informally, Cigna Healthcare offers an appeals process for resolving contractual disputes regarding preservice and post-service payment denials. This process is outlined in our 2023 Medicare Advantage Provider Manual.

Types of appeal forms

Learn more

More information about the Cigna Healthcare Medicare Advantage appeals process is available in the Participating Provider Manual.***

HealthChoice Network News Summer 2023

In this issue
• HealthChoice contracts and a11
• EGID Network Management
• 1!11dating_Y.our billing address
• Fee schedule u11dates
• HealthChoice contact information

Anthem Provider Newsletter – Missouri July 2023

This month’s featured articles:

Administrative 

• Notification of NCCI review of medically unlikely edits
• Unspecified diagnosis code of site and laterality
• Required training – Model of Care
• Maintain your online provider directory information

Digital Tools 

• Provider data management capability now available on Availity Essentials — retirement of previous intake channels October 1, 2023
• Requests for Additional Information are now digital

Education and Training Opportunities 

• Newborn authorizations and baby names
• The BlueCard Provider Manual can answer your questions about the program

Behavioral Health 

• Important information regarding the recent Carelon Behavioral Health, Inc. assignment mailing

Medical Policy & Clinical Guidelines 

• Expansion of Carelon Medical Benefits Management, Inc. Cardiology program clinical appropriateness review for Pacemakers program

Prior Authorization 

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

Reimbursement Policies 

• New reimbursement policy: Multiple Procedure Payment Reduction — Professional
• Reimbursement policy update: Prolonged Services – Professional

Products & Programs 

• Advancing health equity: Leveraging data to promote meaningful patient-provider relationships

Pharmacy 

• Medicare Part B precert expansion may multiple drug alignmentAnthem Provider Newsletter – Missouri July 2023

Cigna – Reimbursement Policy Update – Revenue codes 249-259 and 637 billed without a procedure code 091723

As a result of a recent review, we will administratively deny revenue
codes 249-259 and 637 when billed without a procedure code.

Denials will include administrative appeal rights. Alternatively, providers
may rebill the previously denied revenue code with the corresponding
Current Procedural Terminology (CPT®) or Healthcare Common Procedure Coding System (HCPCS) code.

This update is effective for dates of service on or after September 17, 2023. We will update the Revenue Code Billing Requirements (R41) reimbursement policy to reflect this change.

Please click on the above link to view the complete announcement.