wellcare-wellcare by allwell – covid19 testing screening and treatment 051223

During the PHE, we followed guidance from the Centers for Medicaid & Medicare Services (CMS) and instituted temporary waivers for select services. This action ensured that critical care could be quickly delivered to our members during a time of heightened need. Beginning May 12, 2023, these temporary waivers will expire, and our members’ Medicare plan benefits will be reinstated.

Please review the attached link regarding the specific changes effective May 12, 2023.

Cigna – Reimbursement Policy Update – Procedure and Place of Service 081223

Cigna routinely reviews their coverage, reimbursement, and administrative
policies for potential updates.  As a result of a recent review, they implement the following medical coverage policy updates.

• We will administratively deny Current Procedural Terminology (CPT) or Healthcare  Common Procedure Coding System (HCPCS) codes when billed with an inappropriate place of service (POS).
• This update is effective for dates of service on or after August 12, 2023.

Home State Health Plan is committed to continuously improving its overall payment integrity solutions to prevent overpayments due to waste or abuse. This is a notification that we will begin performing additional prepayment claim reviews on 8/1/2023 using Optum’s Comprehensive Payment Integrity (CPI) tool.  As a result of these prepayment claim reviews, providers may be asked for medical records and billing documents that support the charges billed.

Click on the following link for the complete announcement.

Home State – Optum’s Comprehensive Payment Integrity (CPI) Reviews

HealthChoice Network News May 2023

In this issue

• Venipuncture
• Fee schedule history
• Direct data entry of claims with Availity
• Home Infusion Therapy reimbursement changes
• HCPCS and OP fee schedule corrections for April 1, 2023
• Dental X-rays
• HealthChoice contact information

Wellcare and Wellcare by Allwell require prior authorization (PA) as a condition of payment for many services. This Notice contains information regarding such prior authorization requirements and is applicable to all Medicare products offered by Wellcare and Wellcare by Allwell.

The following link announces changes to their prior authorization requirements effective July 1, 2023.

allwell medicare authorization changes 070123

May 2023 Provider News – Provider News (anthem.com)

This month’s featured articles:

Administrative

• Moving Toward Equity in Asthma Care CME Training and Asthma Medication Ratio HEDIS measure update
• Consolidated Appropriations Act: Review your online provider directory information regularly
• Looking to earn CME credits? Check out the CME Engagement Hub!
• You are invited! Skilled Nursing Facility (SNF) providers: Fall prevention and patient safety
• Updated 2023 provider manual now available
• Submit corrected claims electronically for the Federal Employee Program®
• Important information for providers registered to use Medical Attachments on Availity.com
• Enhanced Provider News website and email communications launching May 1, 2023

Policy Updates

• Transition to Carelon Medical Benefits Management, Inc.* MRI Breast Clinical Appropriateness Guidelines
• New Reimbursement policy: Bundled Supplies and Services – Facility
• Reimbursement policy update: Technology Assisted Surgical Procedures – Professional and Facility
• Reimbursement policy update: Multiple and Bilateral Surgery Processing – Professional

Products & Programs

• Specialty pharmacy updates – May 2023

State & Federal

• Update: Authorizations for DMEPOS services for Medicare Advantage Individual, Group Retiree Solutions, and Dual-Eligible plan members
• Did your patient have a recent fracture?
• Genetic testing
• Keep up with Medicare News – May 2023

Cigna for HCP Update April 2023

Beginning April 27, 2023, the “Am I In Network” tool on the Cigna for Health Care Professionals website (CignaforHCP.com) will be moved to the top of the Patient Plan and Detail screen, and will appear as “Network Status.”

Network Status will work the same as the “Am I In Network” feature by using the selected Taxpayer Identification Number (TIN) and Provider/Group Name to determine network status for your patients with Cigna Healthcare medical coverage.

Learn more
Please refer to the attached for more details on how to use the new feature, and for answers to frequently asked questions.

We want to hear what you think

We appreciate your ongoing feedback as we continue to make enhancements to CignaforHCP.com. You can submit feedback using the feedback tab located on the right side of the website.

If you have any questions, please send an email to .

Thank you for the care you provide to our customers.

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

Cigna Network News 2nd Quarter 2023

HealthChoice Network News Spring 2023

In this issue

• Faxed certification requests are no longer accepted
• Provider appeals
• Network Management contact information update
• Billing with the rendering provider
• Fee schedule updates
• HealthChoice contact information

Please review the following information received from Cigna.

Since the COVID-19 pandemic began, we have taken important steps to deliver timely accommodations to providers and customers, helping to ensure that customers have continued access to COVID-19 diagnostic services, testing, and treatment in safe settings.

Ending the public health emergency period

As you know, the White House announced their intent to end both the COVID-19 national emergency and public health emergency (PHE) on May 11, 2023.

As a result, Cigna commercial and Cigna Medicare Advantage plan to make the following changes on May 12, 2023:

• Authorizations for facility-to-facility transfers will again be required.
• Patient cost-share will apply to COVID-19 lab tests as well as antiviral and therapeutics approved by the U.S Food & Drug Administration (FDA).
• For most benefit plans, COVID-19 vaccines will be covered at 100 percent under the preventive benefit (same as the flu shot) when customers go to an in-network provider.
• Over-the-counter COVID-19 tests will no longer be covered.

Please know that we continue to monitor for any updates from the administration and continue to evaluate potential additional changes to our ongoing COVID-19 accommodations as a result of the PHE ending.