HealthChoice News Update 122223
Featured Articles:
Every day, our providers help us deliver effective care, delivered in a safer environment at a better value.
Please follow the link below for more information related to the change to UHC for FedEx employees that choose that Option.
Cigna – Reimbursement Policy Update – Revenue codes 270-279 billed without a procedure code UPDATE
We recently sent a letter informing you about a reimbursement policy update that would administratively deny revenue codes 249-259 and 637 when billed without a procedure code. We have reevaluated this reimbursement policy change, which affects its implementation.
What this means to you
• The previously communicated update to the Revenue Code Billing Requirements (R41)
reimbursement policy is no longer effective for claims submitted. with revenue codes 249-259 and 637 without a procedure code.
• Claims you may have submitted for dates of service on or after September 17, 2023 that were denied as a result of this policy update will be automatically reprocessed. You do not need to take any action.
If we decide to proceed with this policy update, we will communicate _a new imp!ementation date and additional details. at a later time.
As a First Health provider, you are considered an in-network provider for Curative members.
Curative, a health plan administrator with $0 deductible, $0 copay, and $0 out-of-pocket costs for all in-network care, is now accessing the First Health Network*. Curative has recently expanded its services to include employer groups that will access the network, and our goal is to ensure that there is no question about your network participation and no disruption in care.
Please make sure that your scheduling and front office staff know about your First Health participation so that Curative members can access your services with their in-network benefit. If you have any questions about your network status, please call First Health at 1-800-226-5116, First Choice of the Midwest at 1-888-246-9949, and Cofinity at 1-800-831-1166.
Please ensure that you are reviewing the health plan ID card and submitting claims as indicated on the ID card.
To confirm patient eligibility, please visit https: /curative.corn/eligibility. For electronic billing, please use payer ID: CURTV.
For more information, please visit the First Hea!F1 Network provider page at https:// curatlve. com/first health- network.
Questions about Curative’s plan? Reach out to or call provider support at 855-414-1083. To learn more about Curative, please visit https:/curative.corn.
*Every Curative member qualifies for the $0 deductible, $0 copay for in-network care, and preferred prescriptions by completing a Baseline Visit within 120 days of the plan effective date. See https:/curatlve.corn to learn more.
Arkansas BCBS – Providers News December 2023
This month’s featured articles:
Arkansas Blue Cross and Blue Shield
Federal Employee Program
Medicare Advantage
Blue & You Fitness Challenge
EFFECTIVE JANUARY 1, 2024
We are pleased to announce that, effective January 1, 2024, Express Scripts® will begin processing pharmacy claims for our plan members.
Express Scripts is a pharmacy benefit management (PBM) company serving more than 100 million Americans. Express Scripts Pharmacy delivers specialized care that puts patients first through a smarter approach to pharmacy services.
Members have been notified in advance and will receive a new ID card with updated pharmacy information, so that they are prepared to begin having their prescriptions filled at participating network pharmacies when this change occurs.
Providers can direct members to call the Member Services phone number listed on their ID card should they have questions about this change. You can find frequently asked questions on our website here:
Please contact your Provider Engagement Administrator with any additional questions. As always, we appreciate the care you provide to our members.
Cigna International Health is a segment of Cigna Healthcare business that offers solutions to globally mobile individuals and employers with a portion of their workforce that frequently spends extended time overseas. These plans provide a whole health service platform with a personalized, predictable, and simple customer experience that drives affordability of medical plans. As part of a global organization, we have access to health care support in more than 200 countries and territories around the world.
What you need to know
Types of international customers in the United States
Cigna International Health eligibility, benefits, and precertification Providers can verify eligibility, benefits, and precertification requirements for many Cigna International Health customers by visiting the Cigna for Health Care Professionals website (CignaforHCP.com). If the information cannot be located on the website, please call the number on the back of the customer’s insurance ID card. Cigna International Health claims submission process Please submit your Uniform Billing claim form or Health Care Financing Administration claim form via an electronic data interchange using the payer ID 62308. Important note: Contracted providers are required to request a copy of the Cigna International Health ID card and bill Cigna International Health directly. Any missing required information might result in a delay in payment. Cigna International Health clinical and payment-related appeals process Please submit your appeals for denied claims or precertification requests using the contact information provided on the explanation of benefits and/or denial letter. Cigna International Health reconciliation process
|
Step Therapy programs are developed by Wellcare’s P&T Committee. They encourage the use of therapeutically equivalent, lower-cost medication alternatives (first-line therapy) before “stepping up” to alternatives that are usually less cost-effective.
Step Therapy programs are intended to be a safe and effective method of reducing the cost of treatment by ensuring that an adequate trial of a proven safe and cost-effective therapy is attempted before progressing to a more costly option. First-line drugs are recognized as safe, effective, and economically sound treatments.
The first-line drugs on Wellcare’s formulary have been evaluated through the use of clinical literature and are approved by Wellcare’s P&T Committee. Step therapy is failure of at least one different or less expensive drug prior to coverage of a drug on this list.
Drugs requiring step therapy effective January 01, 2024 can be found under “Resource Documents” here:
https://www.homestatehealth.com
The prescriber, patient, or authorized representative may ask for an exception. Step therapy applies if the drug has not been used in the past 365 days.
As always, we appreciate the care you provide to our members.
Cigna MA – Secondary Diagnosis Codes Update 010124
As a result of a recent review, we will administratively deny a secondary diagnosis code when billed as the primary or sole diagnosis on a claim.
This update aligns with the International Classification of Diseases, 10th Revision, Clinical Modification guidelines and is effective for dates of service on or after January 1, 2024.
Anthem Provider Newsletter – Missouri December 2023
Featured Articles
Administrative
Policy Updates
Products & Programs