RCM eNews – November 2023

You may receive notice that Independence is transitioning to a new claims processing platform starting in 2024. As part of this transition, they will be working with a new vendor to issue medical claim payments, powered by CPR/ECHO Heath.

This transition will not impact how STI receives and processes your payments and 835 files.

For additional information regarding this transition, click here.

Cigna will be moving to a new web-based newsroom for healthcare providers in early 2024. The newsroom will replace the quarterly Network News. More information about how to access the digital newsroom will be coming in the next few months.

For further details on this and more quarterly news from Cigna, click here.

Effective December 1, 2023, Excellus will offer a Dual Special Needs Plan to members who are eligible for benefits from both Medicare and Medicaid. Providers who are currently participating with the Medicare Advantage line of business will be considered in-network for D-SNP. Members enrolled in the D-SNP product will have a VYV prefix.

Only one claim will need to be submitted for processing, the claim will process first under the Medicare benefits and any balance due will then process under the Medicaid benefits.

Providers must be enrolled with New York State and have a MMIS number to receive the Medicaid payments from the plan.

Effective October 1, 2023, eVisits will be reimbursed under Medicaid Managed Care. eVisits may only be provided to established patients, and the patient must initiate communication.

Proper documentation for an eVisit must include:

• The patient-initiated inquiry and the presenting problem
• The clinical assessment and recommendations of the provider
• The total amount of service time related to the eVisit

Physicians, NP, PA, and Midwives may bill for eVisits using CPT codes 99421, 99422, and 99423.

Licensed Clinical Social Workers, Clinical Psychologists, Speech Language Pathologists, Physical Therapists, and Occupational Therapists may bill for eVisits using CPT codes 98970, 98971, and 98972.

Effective for DOS January 1, 2024, UHC Medicare will require prior authorization for medications included in the UHC step therapy program.

Step therapy requires a trial period of a preferred lower cost medications before stepping up to a higher cost medication.

Click here for further information about UHC Step Therapy program.

On January 1, 2024, UHC will be providing healthcare benefits to FedEx employees nationwide, you may be seeing an increase of patients with the United Healthcare traditional health plan, Optum behavioral health, Optum pharmacy, and Surest.

The 2024 Medicare Part B deductible will be $204.00, an increase of $14 from 2023; and the Part B standard premium will be $174.70 per month. The Part A deductible will be $1,632.00. Click here for further details on the 2024 premiums and deductibles.

CMS requires health plans to provide annual education and training to providers who participate in and treat Special Needs Plans (SNP) members, this also applies to dual eligible special needs plan members (D-SNP). As this training is required by each individual insurance you participate with, you may receive multiple notices and requests to complete to and attest to each insurance.

There are several resources available to ensure you follow the No Surprises Act as a healthcare provider.

The AMA Toolkit contains information for healthcare providers to help determine when the stipulations of the No Surprises Act may be applied, as well as how to manage and provide Good Faith Estimates.

CMS also has published resources for patients and providers, which can be viewed here.

If you need to provide a Good Faith Estimate to a patient, CMS has offered a template of what to include in the estimate.