Every day, our providers help us deliver effective care, delivered in a safer environment at a better value.
The UHC September Virtual Provider Expo is scheduled for September 12, 2023 from 8:30 – 3:00 PM Central Time. There will be several sessions throughout the day with the option to earn continuing education credits for attending these presentations:
You can find more information on this as well as how to register by following the link below.
The September edition of the Medica Connections is now available for review by following the attached link.
The following topics are covered in this edition.
General News
Pharmacy News
Administrative News
Home State Health – Wellcare by Allwell Prior Authorization List 100123
Please click on the above link to access the announcement from Wellcare by Allwell regarding updates to their prior authorization list effective 10/1/2023.
Home State Health Provider News – Babylon Provider Alert
We’d like to update you on some important information regarding our Ambetter Virtual Access members’ telehealth coverage. Babylon Health’s telehealth services are no longer available as of August 7, 2023. Due to this change, you may receive new requests for both virtual and in-person services from Ambetter Virtual Access members as you are currently in our network.
As always, please verify each member’s eligibility, benefits, and
referral requirements before rendering care.
To view the full announcement, click on the link above.
As you know, we took important steps through COVID-19 to deliver timely accommodations to providers and customers, helping to ensure that customers had continued access to COVID-19 diagnostic services, testing, and treatment in safe settings.
How we reimbursed COVID-19 services
As a reminder, we have been reimbursing providers at contracted rates for COVID-19 related services (e.g., vaccine administration, infusion treatments, and testing) only when provider-specific rates were in place for certain COVID-19 services. When no contracted rates were in place, we reimbursed providers for all covered COVID-19 services billed under the medical benefit at the established national Centers for Medicare & Medicaid Services (CMS) rates.
This reimbursement approach was put in place at the onset of the pandemic to ensure that providers received timely, consistent, and reasonable reimbursement.
Updating how we reimburse these services as of August 1, 2023
At the end of the public health emergency period – May 12, 2023 – we communicated that we would continue to follow this reimbursement guidance in the interim while targeting August 1 to pay all providers at contracted rates, including reverting to a default discount for providers who don’t have specifically negotiated rates for COVID-19-related services.
Please note that we are now reimbursing all participating providers at contracted rates for COVID-19-related services beginning with August 1 dates of service (subject to applicable law).
Get the most up-to-date information
Our dedicated COVID-19 provider web page was recently updated to highlight these changes. I encourage you to review this page for the latest information.
Click on the following links to access the current edition of Cigna Network News
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.
Anthem Provider Newsletter – Missouri August 2023
This month’s featured articles:
Featured Articles
Administrative
Policy Updates
Products & Programs