Volume 03 | November 20, 2020
Your Guide to News & Updates
Action Items- We Need Your Help!
Important Update: Cigna Piedmont Healthcare System Plan

We wanted to take the opportunity to inform you of a recent win with Cigna Healthcare. It was brought to our attention from many of our network practices that patients employed by Piedmont Healthcare- and insured under the Cigna Piedmont Healthcare System plan, have been experiencing claims being processed out of network. Unfortunately, many employees of Piedmont Healthcare that have chosen a Kids Health First provider as their child’s pediatrician have had to deal with this inconvenience. 

We have received confirmation from Cigna earlier this week that all Kids Health First providers in our CSN will be loaded as Tier 1 providers. The estimated completion for this provider load is by November 30th. 

Cigna has also informed us that after the completion of the provider load, all patient claims that have already been submitted will be reprocessed and reimbursed as a Tier 1 provider going back to January 1, 2020. 

If your practice has been holding any Cigna Piedmont Healthcare System claims during this time period, we ask that you continue to hold the claims for the time being. We will send an official notice to all KHF practices as soon as Cigna notifies us of the completion of the provider load. 
KHF would like to send a sincere thank you to all of our member practices for their hard work and assistance in helping us resolve this issue. This outcome was truly brought about by a team effort. Several practices sent us their submitted claims, reference numbers from calls with Cigna, and other official documents that helped us make our case to our Cigna and Piedmont Healthcare partners to bring about this successful outcome. 

We also want to send a huge thank you to our KHF billing and finance committee members for their help and guidance throughout this process. This is a prime example of the goals we can achieve when we pull together as a network. 

Please stay tuned for further updates as they become available. If you have any billing or payor related questions, please reach out to Toni Williams at twilliams@khfirst.com.
Dr. Tuck Pediatric Coding Seminar- Slides and Recording

Thank you to all who joined us for our informative pediatric coding seminar with Dr. Tuck yesterday!
Please click the links below for a pdf version of the slides (we improved the layout slides 36 and 37 of the presentation from yesterday for clarity) and well as the recorded webinar.
Update on CPT 99072

Unfortunately, at this time no payor has a policy that will cover the additional supplies or time needed during the pandemic (CPT 99072).

Many organizations, including the AAP, are lobbying for this change. However as of today, the decision is still up to the payor unless a mandate is made at the state or federal level. We will keep you updated as more information is made available.
Payor Distribution & Billing Champion List

Kids Health First is committed to supporting our member practices through regular and frequent communication about important payor updates that affect your practice’s revenue cycle. As part of this continued support, we are currently updating our distribution lists and asking for your help in doing so.

We are asking that every practice appoint an individual to serve as their practice’s billing champion. This person will serve as our main point of contact for all payor and billing related correspondence.

Please submit the billing champion spreadsheet here and submit to payorconcerns@khfirst.com.
Payor Updates
Aetna
KHF is working with Aetna on several claims related issues. We are asking for your feedback on the following- the information you provide will help us as we work with Aetna to bring resolution to the below issues.

Please let us know if you are experiencing any of the below claims issues:

  • Hep B vaccine denying as non-covered or due to age of patient
  • Underpayment for vaccines
  • CPT 96160 denials
  • Vaccination denials (include CPT codes)
  • Office visit or vaccination denied when billed together
  • Other claims issues with Aetna

Please include a rough estimate of claims issues, we do not need a spreadsheet of actual claims as we are trying to ascertain the scope of these issues and how many KHF practice are affected by them.

If you are experiencing any of these issues, please send an email to payorconcerns@khfirst.com
Cigna
Interim COVID-19 Coverage Guidelines Extended

Cigna's interim COVID-19 coverage guidelines were set to expire on October 31, 2020. To further help ensure providers can continue to deliver care how and where patients want it, Cigna is extending the interim coverage guidelines, as follows:

  • The cost-share waivers for COVID-19 diagnostic testing and related office visits are extended until January 21, 2021.

  • The cost-share waiver for COVID-19 related treatment is extended until December 31, 2020.

  • Most other interim accommodations (e.g., administrative relief policies) are extended until December 31, 2020.

View Cigna's updated COVID-19 provider web page for additional information on key topics and policy updates.
Humana
Several practices have reported a delay in payments from Humana at this time.

We have brought this to the attention of our Humana rep and the issue is currently being reviewed.

Please stay tuned for further updates!
United Healthcare
Updated Process to Submit Claims Issues and Revenue Cycle Opportunities (RCO)

UHC recently updated their process for submitting claims issues. The steps to submit a claims issue to UHC are listed below:

  • If you have a claims issue or RCO that you would like UHC to review, please submit a case on LINK, UHC's self-service online tool. Click here to access and view additional information on how to get started.


Please be sure to fill out all fields completely and include all case numbers as applicable.
Toni's Tips
Reminders & Quick Tips
Tip 1:

Please pay close attention to BCBS plans.

Patient benefits and reimbursement guidelines can vary based on the location of the home plan and not necessarily where the patient lives.

An example would be a patient working for Walmart and the plan is based out of Arkansas, despite the family living and working in Georgia.

Yes, the local Blue will process the claims but the sate and/or plan guidelines will dictate the reimbursement rules.


Tip 2:

When seeking information from sources please compare that information with what the payor, plan, and contracts state!
Resources For You