Clinical News

• Medical policies and clinical guidelines to be updated – Effective August 15, 2022

Pharmacy News

• A link to the latest Summary of Changes is included
• Medica to add new UM policies for 1 new medical pharmacy Drugs – Effective August 1, 2022 -A9699 Pluvicto
• Upcoming changes to Medica Part D drug formularies – Effective July 1, 2022

Network News

• Effective 09/01/2022 Medica will implement standard ancillary fee schedule updates for all Medica products. This will impact several areas and these can be viewed by following the link to the newsletter.

Administrative News

• Provider administrative training webinar for July: Navigating Provider Resources.  View the newsletter for details.

Medica July 2022 Newsletter

This month’s featured articles:

• Changes to our National Precertification List
• Site-of-service coding update
• Computer-assisted surgical and musculoskeletal navigation coding update

July 2022 OLU

The June edition of the Healthy Blue Medicaid Provider News is available by following the link below.

Healthy Blue Medicaid June 2022 Newsletter

A brief overview of the topics covered

• COVID-19 updates
• Effective 09/01/2022 Healthy Blue will start reviewing selected claims for COVID-19 visits when billed with E&M service to ensure they align with CMS reporting guidelines. Please review with your clinics and billers.
• There are several provider coding classes being offered and a link is included to review and register.
• Updates to AIM Specialty Health Clinical Appropriateness Guidelines for Advanced Imaging, Sleep Disorder Management and Musculoskeletal
• Updated list of DME codes that will require prior authorization effective 07/01/2022.

Effective 07/01/2022 Home State Health will be rolling out a new plan, Show Me Healthy Kids.  This is a sole source foster care plan for the Missouri market designed to ensure that some of the most vulnerable members of MO HealthNet receive quality care.

Show Me Healthy Kids Announcement

The FAQ will answer the majority of your questions but we have listed a few items below:

• There will be a new ID card issued that clearly states Show Me Healthy Kids
• If you are an existing Home State Medicaid provider you will automatically be enrolled with the plan.
• If you currently see foster care patients and you’re not a Home State Medicaid provider you will need to enroll with them to continue care.
• You will generally follow the same procedures as you would if you were to see a Home State Medicaid member with two appointment requirements that are different:
  • An appointment with a PCP within 24 – 72 hours of being initially placed into care
  • A comprehensive exam within 30 days of being placed into care

FAQ link

Show Me Healthy Kids FAQs

A new direct contract has been signed between Mercy and Buchheit effective July 1, 2022. Claims will be priced by Mercy Benefit Administrators and Auxiant will serve as their claims administrator.

A sample of the group’s identification cards is attached.

Buchheit

Claim Address:            Auxiant  PO Box 909991  Milwaukee, WI  53209

Trizetto Payor ID #: 53209

Claims & Eligibility: 1-800-279-6772

Precertification: 1-866- 726-6584

B1065-04.HSA Base Buchheit 07012022

B1065-03.Trad buy up Buchheit 07012022

Home State Health partners with Magellan to manage outpatient cardiac imaging to assist physicians in the timely management of patients with possible cardiac disease.

Have you ever thought about ways to improve the authorization process for cardiac services? Then share your feedback with us!

On June 16, 2022, and June 30, 2022, we will host cardiac provider experience workgroups and would love to hear your ideas for creating a better experience! These hour-long webinar sessions are an ideal opportunity for you to share your opinions and collaborate with us on an authorization process that better suits your needs.

For more information: Home State Health – Cardiac Provider Experience Workgroups

Dear Behavioral Provider,

At Evernorth Behavioral Health, we are committed to making your life easier by continually improving your digital experience and providing self-service tools to improve your office’s efficiency and reduce administrative burden.

On December 10, 2021, we launched Provider.Evernorth.com, the new website for behavioral providers. If registered, you will continue to use your Cigna for Health Care Professionals website (CignaforHCP.com) credentials to log in.

We invite you to explore the digital solutions available to you, watch brief video tutorials, and browse through other resources available through the provider website. Topics include:

+ Access and registration: Users must be registered to access many of the resources available on the provider website. If you haven’t already signed up for site access, you can self-register here. If you would like to learn more, view the Access and Registration video tutorial.

+ Electronic Funds Transfer (EFT) online enrollment and management: By enrolling in EFT you can eliminate paper check delivery and handling, and gain access to funds the same day as a deposit. EFT also allows you to improve payment bulking and reconcile payments more easily using a single remittance tracking number. To learn more, view the Electronic Funds Transfer (EFT) resource page.

+ Online remittance reports: The online remittance report is an explanation of your processed claims, which includes direct deposit activity and checks with explanation of payment. Access and view your online remittance reports the day you receive your deposit. To learn more, view the Online Remittance Reports resource page.

+ Procedure code benefit lookup: For PPO policies, access your patient’s benefit information with ease by using a procedure code. Use this tool to view patient benefit information for selected procedure codes when performing an eligibility and benefit search, verify if precertification is required, see the completed and remaining status when a benefit has limitations, and save benefit reference numbers. To learn more about the procedure code benefit lookup feature, view the Eligibility and Benefits video tutorial.

+ Claim reconsideration and appeals: The online claims reconsideration feature provides users with appropriate access and the ability to submit and check the status of appeals and claim reconsideration requests 24/7. To learn more about this feature, view the Claim reconsiderations and appeals online: Step by step guide.

Additional information
Interactive web-based demonstrations of the Evernorth Provider website are available. To learn more about our free webinars, view the webinar schedule.

For more information and additional resources, visit Provider.Evernorth.com > Resources > Behavioral Health Education and Training.

Thank you for your continued partnership and ongoing commitment to provide quality behavioral health services to our customers.

Sincerely,

Network Operations Management
Evernorth Behavioral Health

https://wlink.graphnet.com/maximail/viewviaweb.htm?reqinf=1376017979G212532658G0EAFBBE3450E04FB4C2A474E9588F934

This month’s featured articles:

Arkansas Blue Cross and Blue Shield

• 2022 Spring Provider Workshops
• My Blueprint upgrades to Blueprint Portal
• Alacura medical transport network deadline -July 1
• Availity® transition: Filing claims correctly
• COVID-19 update for members covered by Arkansas Blue Cross and Blue Shield and Health Advantage (fully insured health plans)
• Advanced diagnostic imaging prior approval for ASE/PSE & Arkansas State Police
• Prior approval for long-term/rehab facilities returns for ASE/PSE & Arkansas State Police
• Utilization Management Transformation Project
• Coverage Policy manual updates
• Standard Formulary revisions effective July 1, 2022
• Metallic Formulary revisions effective July 1, 2022
• Medical specialty medications prior approval update

Federal Employee Program (FEP)

• Advanced diagnostic imaging prior approval for FEP
• New Directions Behavioral Health contracts on behalf of FEP
• HEDIS®Improvement CPT II Coding Guide
• HEDIS® measure-cervical cancer screening

Medicare Advantage

• Sequestration Update
• Medicare Advantage Billing Guidelines with Screening for Hepatitis B Virus (HBV) Infection Screening

Arkansas BCBS – Providers News June 2022

Home State Health Plan
Diagnostic Imaging or Other Procedures
(including Cardiac, Ultrasounds & Sleep)
Utilization Review Matrix – 2022

NIA has developed a matrix in an effort to help its clients set up their claim processing systems.  This matrix is designed to assist in the resolution of claims adjudication and claims questions related to those services managed by NIA.

View the Matrix here:

NIA Home State Utilization Review Matrix 5.27.22 Medicaid_Medicare

Cigna routinely reviews their coverage, reimbursement, and administrative policies for potential updates. In that review, they take into consideration one or more of the following: Evidence-based medicine (EBM), professional society recommendations, Centers for Medicare & Medicaid Services (CMS) guidance, industry standards, and our other existing policies.

As a result of a recent review, they will require the submission of office notes with claims submitted with evaluation and management (E&M) Current Procedural Terminology (CPT®) codes 99212, 99213, 99214, and 99215 and modifier 25 when a minor procedure is billed.

The E&M line will be denied if we do not receive documentation that supports that a significant and separately identifiable service was performed. Denials will include administrative appeal rights.

This update is effective for claims processed on or after August 13, 2022. Please note that the requirement to submit documentation only applies to claims that include one or more office-based minor procedures.

Please click on the following link to view the complete announcement from Cigna.

Cigna – Reimbursement Policy Update – E&M Codes Billed with Modifier 25 081322