Federal Public Health Emergency Extended
The PHE has been extended again and is now set to expire April 11, 2023.
With each PHE extension, numerous flexibilities and waivers remain in effect, including Medicare telehealth coverage. Please note that not all waivers have been renewed for skilled nursing and long-term care facilities.
Once the end of the COVID-19 public health emergency occurs, the Consolidated Appropriations Act, has ensured a 151-day extension period before many of the policies outlined in the COVID-19 public health emergency are set to expire, to allow for a transition period.
Cigna Digital ID Cards
Cigna continues to leverage the power of technology and data to accelerate its transition to fully adopt digital-only ID cards by 2024*. This important industry-leading approach to digital ID cards is the next step to offer more digital-first solutions for customers and providers.
Digital ID cards are not completely new for Cigna. Today, nearly all their customers have access to a digital ID card through the myCigna® app or the myCigna.com® website, and you may have already noticed some patients presenting you with a digital version of their ID card in your office. However, throughout 2023, you may begin to see more patients with a digital-only ID card.
Patients may more frequently start to present your office with their digital ID cards. Your patients will have the option to:
- Share their digital ID card image on a phone screen in the office
- Relay the information verbally over the phone to preregister for their appointment
- Upload a digital ID card image to your health portal
- Email a digital ID card image directly to your office from the myCigna app
- Print a copy of their digital ID card and share it with your office
For further details, click here.
* Some states have mandates that prohibit digital ID cards. Colorado, Texas, Minnesota, New York, Florida, and Georgia have certain exclusions. Patients residing in these states may continue to receive physical ID cards in the mail depending on their plan type.
Clover Payer ID Change
Excellus BCBS: Physical Therapist Reimbursement
For Commercial Products:
Effective March 1, 2023, physical therapists who have completed the Pathway Trained Provider (PTP) training will receive an additional 8% above community rated for services provided to Excellus members covered under a commercial product for any physical therapy diagnosis code.
Practitioners are eligible for this enhanced reimbursement within approximately 60 days of completing the PTP training. The nationally recognized Spine Health Program sponsored by Excellus, in cooperation with Spine Care Partners LLC is available immediately upon registration. There is a $50 one-time registration fee for 12 CE credits, or no-cost registration without CE credits.
To register, click https://provider.excellusbcbs.com/.
- Standard allowance for the initial physical therapy eval will remain at $67
- Allowance for PTP’s will be $72.36 when billed for any diagnosis
- Standard allowance will remain at $50
- Allowance for PTP’s will be $54 when billed for any diagnosis
Effective April 1,2023, Medicare reimbursement will conform to the same 2023 professional fee schedule rates that you receive for treating your traditional Medicare fee-for-service patients, except for the physical therapy assistant reduction implemented by CMS in 2022. At this time, Excellus will not reduce reimbursement for services rendered to Medicare Advantage members by physical therapy assistants.
Excellus BCBS Reminder: TransactRx for Medicare Advantage Members
Effective February 1, 2023, Excellus will require the use of the TransactRx Billing Tool when vaccines are administered in the office to Medicare Advantage Members.
TransactRx is an independent company that offers a free, real time, and efficient online tool for providers to bill Part D vaccine claims administered in the office. The tool also allows providers to determine:
- If a member has Medicare Part D coverage and the plan in which the member is enrolled
- How much the provider will be reimbursed for the vaccine. There is no need to bill the administration fee separately because it is included in the Part D vaccine reimbursement
- Diphtheria/Tetanus (Tenivac®)
- Tetanus, diphtheria toxoid and acellular pertussis (Adacel®, Boostrix®)
- Zoster vaccine recombinant, adjuvanted (Shingrix®).
Failure to submit claims for Medicare Part D vaccines through TransactRx with dates of service on or after February 1, 2023, will result in a denial and the provider will be held liable. Members cannot be billed for the vaccine.
We strongly encourage you to enroll with TransactRx prior to February 1, 2023, to avoid any interruption in reimbursement. To learn more, enroll, or to register for a TransactRx demonstration free of charge, go to www.transactrx.com/physician-vaccine-billing.
If you opt not to use the tool, we recommend that you direct our Medicare Advantage members to obtain Part D vaccines at their local in-network pharmacy.
Fidelis Care NY – New Denial Code
Fidelis Care would like to inform our providers that a new claim denial reason code is in process for duplicate claim resubmission submitted on the same day.
EX CODE: 5V
Description: Exceeded daily submission limit (or frequency) for this claim
Fidelis Care will process the first corrected claim received. Any duplicate submissions of the claim on the same day will reject through the Electronic Data Interchange (EDI) system with the code 5V. This claim denial will not show on the remittance.
Providers will continue to see denial reason code 9L for invalid corrected claims.
Molina Healthcare Updates
Claims Submissions:
Effective 1/1/2023, Molina will no longer accept claims submitted via non-approved submission pathways. Molina accepts claims electronically via clearinghouse and through the Availity portal. Molina also accepts paper claims on original (red colored) CMS-1500 and 1450 (UB-04) claim forms sent to the Molina Claims PO Box found in the Provider Manual, and on the Member ID card (P.O. Box 22615, Long Beach, CA 90801).
ProviderNet Sunsetting Notice
Molina Healthcare Inc’s contracted vendor, Change Healthcare, will be sunsetting their ProviderNet portal as of 01/01/2023.
If you or your clearinghouse were accessing 835 files and Explanation of Payments from this portal for payments issued prior to Molina’s migration to ECHO Health Inc portal, you will no longer have access to these documents through ProviderNet and will need to request them from Molina (for 835’s) or access the Explanation of Payments through Availity.
For further details on these updates and other news items can be viewed here.
Attention New Jersey ENT Providers – Updated Code for Repair of Nasal Valve Collapse
The long-awaited Nasal Valve code for VivAer® has arrived. Effective January 1, 2023, CPT® 30469 will replace CPT® 30999 for treatment of Nasal Valve Collapse.
The new reimbursement based off CMS NJ Medicare data starting 1/1/23 is as follows:
30469 (Paid at 100%): $2949.24
30117 (Paid at 50%- 2nd line) $567.74
30117 (Paid at 50%- Third line) $567.74
30801 (Paid at 50%- Fourth line) $127.19
Total: $4,211.91
New York Medicaid Managed Care Enrollment
Please be aware that if you accept any of the New York State Medicaid Managed Care Plans, you must be enrolled in the New York Medicaid program.
Several Medicaid Managed Care Plans have begun denying claims if the NPI on the claims are not enrolled.
This policy aligns with the 21st Century Cures Act, which requires all Medicaid Managed Care (MMC) and Children’s Health Insurance Program network providers to be enrolled with state Medicaid programs no later than Jan. 1, 2018.
For additional information and requirements from United Healthcare, click here and from Excellus BCBS, click here.
Novitas Solutions: Jurisdiction H, Part B Claims Issue
United Healthcare: VCP Statements are Going Digital
Starting Feb. 3, 2023, United Healthcare will no longer mail virtual card payment (VCP) statements (excluding UnitedHealthcare commercial and Medicare Advantage Plans of Colorado; and Behaviorial Health), to network health care professionals (primary and ancillary) and facilities currently receiving VCP statements by mail. This applies to payments for commercial and UnitedHealthcare® Medicare Advantage plan claims only. VCP statements for UnitedHealthcare Community Plan (Medicaid) plans will continue to be mailed at this time. This change doesn’t affect health care professionals and facilities who receive payment through electronic funds transfer/automated clearinghouse (ACH).
For further details and information on how to view virtual card payment statements, click here. Or, if you need assistance opting out, please contact your Account Manager for help.
United Healthcare Reminder: Appeals & Reconsiderations are Digital
As of Feb 1, 2023, United Healthcare is requiring all post-service appeals and claim reconsiderations to be done electronically.
Submission requirements:
There is a 2-step process for network health care professionals and facilities if they don’t agree with the outcome of the original claim payment or denial. (Claim reconsiderations don’t apply to some states based on applicable state law.)
Step 1 is to file a claim reconsideration request. Step 2 is to file an appeal if you disagree with the outcome of the claim reconsideration decision. The 2-step process allows for a total of 12 months for timely submission of both steps. More information can be found in the Network Administrative Guide at UHCprovider.com/guides.
What’s Ahead in Paperless
In 2023, you can expect more paper submissions and mailings to go digital. Later in 2023, United Healthcare will require you to submit claims and claim attachments electronically. They will also continue to encourage UnitedHealthcare commercial members to use digital ID cards.
All required paperless transitions will be announced in Network News at least 90 days prior to the change. You are encouraged to explore their digital solutions and review your workflows so that your team is prepared. Review the most up-to-date information, exclusions and schedule at UHCprovider.com/digital.