Beacon Health Options Name Change
As of March 1, 2023, Beacon Health Options new name is Carelon Behavioral Health. This name change does not change any contract or reimbursement and will not change coverage for your patients. This is a new healthcare services brand and not a change in ownership.
All existing phone numbers, emails, websites and portals will redirect with no additional registration required.
CDPHP Fee Schedule Updates
- Commercial Products – 3% increase
- Medicare Products – converted to the 2023 CMS RVU’s for all providers
- Medicaid, Essential Plan, & Child Health Plus – no changes
Excellus BCBS Expiration of Covid-19 Regulations
Claims submitted with a date of service on or after May 11, 2023, should not include modifier CR or conditions code DR.
Place of Service (POS) codes 02 and 10 will be the only POS allowed for billing telehealth professional services.
Eligible telehealth services will continue to be reimbursed at the same as equivalent in-person services.
The Health Plan will continue to follow the CMS telehealth code list for valid telehealth codes.
Timely filing and internal/external appeal time frames in place prior to the COVID-19 national emergency will resume on July 11,2023.
CMS 1135 Waiver will expire on May 11,2023. The waiver suspended provider background checks, extended existing preauthorization, lifted the 3-day prior hospitalization requirement for skilled nursing facility admissions, granted permission to requesting hospitals to temporarily bill swing bed services, and expedited appeals for Medicaid Managed Care/Health and Recovery Plan and Child Health Plus lines of business.
Covid-19 Testing Guidelines:
- Commercial Fully Insured and Self-Funded Groups – Cost-share for Covid-19 lab and OTC testing will resume for dates of service on and after May 12,2023.
- Medicaid Managed Care – Lab testing cost-share will resume for dates of service on and after October 1, 2023.
- Child Health Plus – Lab and OTC testing cost-share will resume for dates of service on and after October 1, 2024.
- Essential Plan – awaiting NYS DOH guidance.
- Medicare Advantage – coverage of OTC tests end after May 12,2023. Cost-share for lab testing resumes for dates of service on and after May 12,2023.
Covid-19 Vaccines and Administration Guidelines:
Continue to bill only for the administration fee if you have received the Covid-19 vaccine at no cost from the federal government.
Once the Covid-19 vaccine is no longer supplied for free by the federal government, the following will apply:
- Medicare Advantage – all MA plans must cover Covid-19 vaccines with no member cost-sharing.
- Medicaid Managed Care – Covid-19 vaccines will be covered with no cost sharing through September 30,2024.
- Commercial – vaccines will be covered as a preventive benefit with no cost-sharing.
Covid-19 Therapeutic Treatment Guidelines:
Existing emergency use authorizations (EUA) for Covid-19 products will remain in effect. Most Covid-19 therapeutics are expected to transition to the commercial marked by mid-2023, each product will have a unique commercial transition period.
- Commercial – once the government supply of oral antivirals is depleted, cost-sharing will be applied.
- Medicaid Managed Care and Child Health Plus – Covid-19 treatments will continue to be covered without cost-sharing through September 30,2024.
- Medicare Advantage – No change in Medicare coverage of therapeutic treatments for those exposed to Covid-19, in cases where cost-sharing and deductibles apply now, they will continue to apply.
Humana Virtual Credit Card Payments
Beginning in May 2023, Humana may enroll your office to receive claim payments via virtual credit card in collaboration with PNC Healthcare and ECHO Health, Inc. You may opt out of participation in the virtual card program by calling ECHO Health at 888-483-9212.
If you receive notification that you have been entered into the virtual card program, and you prefer to enroll in electronic remittance advice and electronic funds transfer (ERA/EFT) instead, please use the ERA/EFT enrollment tool on the Availity Portal, and be sure to decline participation in the virtual card program by calling ECHO Health as soon as possible after receiving your virtual card program notification
Medicaid Re-Enrollment
The Consolidated Appropriations Act, 2023, delinked the end of the FFCRA’s Medicaid continuous enrollment condition from the end of the COVID-19 Public Health Emergency. As a result, the Medicaid continuous enrollment condition will end on March 31, 2023. States will soon resume normal operations, including restarting full Medicaid and CHIP eligibility renewals and terminations of coverage for individuals who are no longer eligible. Beginning April 1, 2023, states can terminate Medicaid enrollment for individuals no longer eligible. States will have up to 12 months to return to normal eligibility and enrollment operations.
Patients will need to act to stay insured. Over the next 12 months most patients will need to renew their Medicaid, Medicaid Managed Care, Child Health Plus and HARP plans.
Be sure to check patient eligibility to ensure coverage and check for coverage end dates. Encourage your Medicaid patients to complete their recertification paperwork.
Click here for further details.
Medicare Telehealth Service Post PHE
- Virtual check-in codes (G2012, G2010, G2252) and remote patient monitoring codes will only be allowed for established patients after the PHE ends.
- Medicare will continue to cover audio-only telephone service codes 99441-99443 through Dec 31, 2024.
- Behavioral and mental health service codes 90785-90840 have been permanently added to the Medicare Telehealth Services List and may be provided using audio-only through Dec 31,2024.
- All other services on the Medicare Telehealth Services List will require audio-video equipment, unless otherwise indicated.
- Incident-to via virtual supervision will not be allowed after Dec 31,2023.
- All telehealth platforms must be HIPAA compliant as of May 12,2023. Smart phone options such as FaceTime or Skype will no longer be an option.
- Modifier 95 will continue to be used for Medicare audio-visual services through 2024.
- Modifier 93 must be used for all audio-only services.
- Audio-only services will be heavily scrutinized and should be performed on rare occasions and the medical record must reflect why the patient was unable to participate in an audio-visual visit.
United Healthcare Online Credentialing
In June 2023, all medical healthcare professionals will use Onboard Pro to begin the credentialing and contracting process with United Healthcare. Onboard Pro will replace the Request for Participation portal.
Onboard Pro is an easy-to-use tool found in the UnitedHealthcare Provider Portal. It integrates with the Council for Affordable Quality Healthcare (CAQH) ProView® and other state-specific credentialing applications. Onboard Pro will automatically retrieve most of your demographic and credentialing information from those applications and lets you know immediately if additional information is required. Your personal dashboard shows the real-time status of every enrollment request you’ve submitted.