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

UHC is offering and “Ask and Advcoate” webex meeting for the AR region providers.  Preregistration is required by following the link below.

Host:  Jasmine Simpson

Wednesday, May 17th

10:00 AM

UHC Monthly Provider Education Registration

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.

The national education team has posted their upcoming education webinars, if  you would like to share with your employees we would love to have you all.  Please share where you feel necessary.

Upcoming topics include:

• Chronic conditions and accuracy of documentation.
• HEDIS® Pregnancy and OB care.
• Health equity and reducing disparities.
• HEDIS Electronic Clinical Data Systems.
• Trauma informed care.
• Understanding risk adjustment.

Please register by following the link on the attachment at least 24 hrs prior to the start of the event.

MOHB-CD-023579-23 Prov Educ Web Invite_FINAL

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

The May 2023 Medica Connections is now available for viewing.  Some of the items addressed are listed below:

• Electronic submission of prior authorization requests now available
• Medica to expand concurrent review program to inpatient NICU admissions effective July 1st, 2023
• Various Clinical and Policy guidelines will be updated effective 06/19/2023 and a link is available to view those on the attachment
• Previous UM Policy Change for Prolia/Xgeva does not apply to Medica Prime Solution (Medicare Cost) members
• The drug management policies can be reviewed in their entirety by following the link on the attachment
• Effective 07/01/2023 Medica will update their Medicare physician fee schedules

May2023Conn – Final

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.

Home State Health offers some helpful links to better equip your practice.  Please click on the following link to view their information.

Home State Health – Important Provider Tips 041323

We received notice from UHC regarding Virtual sessions they are hosting for our Mercy hospitals, physicians and ancillary providers to review their Individual Exchange product.  This should provide quite a bit of information and will hopefully answer any questions you might have.  Please feel free to forward this to any of your staff that might benefit.

Is Your Team Familiar with our Exchange Plans?

We would like to help.  Please join us to learn more about the UHC Individual & Family Exchange Plans. We will identify plan types, explore plan features, work with the plan, and more.

 Individual & Family Exchange Plan Virtual Lunch and Learn Sessions 

Register Today By Clicking on the Date/Time Options Below (Feel free to forward within your team as well.)  Registration IS required to attend:

Wednesday, February 22, 2023, 12:00pm – 1:00pm CST

Thursday, February 23, 2023, 11:00am – 12:00pm CST

Visit UHCprovider.com/exchanges to access:

• The 2023 Individual Exchange plans self-paced interactive guide
• Our policies, coverage determination guidelines and prior authorization requirements
• State-specific prescription drug lists (PDLs)
• Individual Exchange plan news