Please review the communication we sent on April 12, 2023 to learn more about the available program materials including a timeline checklist, tip sheets, and more. You can also access these materials through our website (log in required).

Learn more about the program by watching the 2023 Clinical Integration Program Webinar. (log in required)

Review Your Customized Reports for PCPs

On April 5th, adult PCPs and pediatricians in our network received customized reports in their One Drive account. Please be sure to view these reports — including the patient opportunity report that shows you patient-level information on care gaps and patients that need to be seen for appointments. 

Your Q4 2022 Care Coordination Payment

Eligible PCPs were mailed their Q4 2022 care coordination payments. Panel reports were also sent via secure email detailing all of your patients that are attributed to your practice so you know how your Care Coordination payment was calculated.

Now Available: 2023 Contracts Quick Guide

Refer to the 2023 Contracts Quick Guide to see which payers the CIN contracts with.

Other payer resources

• 2023 Voluntary Payer Plan Product Grid
• Reimbursement rates for top E&M codes for Manhattan localities are now available on our website (login required)
• Your customized Health Plan Participation Summary is available on our website (login required)

Please note that providers are required to check eligibility/verify coverage before care is provided.

MSHP Board of Managers Spotlight

Meet our Mount Sinai Health Partners’ Board Member, Michael Yaker, MD. Dr. Yaker is a pediatrician at Westside Pediatrics. We recently caught up with Dr. Yaker to learn more about him as a MSHP Board member! 

We look forward to Dr. Yaker continuing to

serve on MSHP’s Board of Managers! 

Interested in becoming part of MSHP's governance? Join a committee today! Reach out to Lauren Hertan to learn more about how you can participate. 

Use single-pill combinations as a first line of pharmacologic treatment for hypertension

The literature has demonstrated that patients on single-pill combination (SPC) therapy for hypertension are more likely to comply with their medication regimen. Improved adherence and persistence are likely to improve blood pressure (BP) control.

Learn more

United Healthcare Erroneous Termination Notification

Earlier this month UnitedHealthcare issued a letter in error to their Medicaid members under the care of some of MSHP’s Clinically Integrated Network (CIN) physicians. The letter erroneously advised them that their physicians were terminated due to their affiliation with Mount Sinai Health Partners. The MSHP IPA does not participate with United’s Community Plan products, and never has, and this letter was sent in error by United.

Please review this communication we sent on April 5, 2023 for more information.

United Healthcare Policy Updates

United Healthcare shared their medical policy updates and reimbursement updates. Some key updates include the following:

• Outpatient procedure site of service
• Preventative medicine screening
• Screening colonoscopy procedure site of service

Cigna COVID-19 Coverage Changes

Effective May 12, 2023 the following coverage changes will apply to Cigna commercial and Cigna Medicare Advantage plans:

• Authorizations for facility-to-facility transfers will again be required
• Patient cost-share will apply to COVID-19 lab tests as well as antiviral and therapeutics approved by the U.S Food & Drug Administration (FDA)
• For most benefit plans, COVID-19 vaccines will be covered at 100 percent under the preventive benefit (same as the flu shot) when customers go to an in-network provider
• Over-the-counter COVID-19 tests will no longer be covered

Learn more

Cigna Medicare Advantage Prior Authorizations

Cigna updated their Medicare Advantage Authorization Requirements grid for dates of service on or after April 1.The updated Cigna Medicare Advantage Authorization Requirements grid can also be found on the Cigna Medicare Advantage Providers website.

Cigna Tips for Managing Third Party-Administered Benefits

Some employer groups may use a third party administrator (TPA) to administer their benefit plans. If your patient has a TPA-administered plan, you should contact the TPA for questions related to:

• Eligibility
• Benefit administration
• Claim status, payment, and administrative appeals
• Authorization requests

Note: Cigna cannot answer questions related to the topics above for patients with TPA-administered plans.

How to determine if your patient has a TPA-administered plan

Option 1: Patient’s ID card

A patient with a TPA-administered plan will have the letter “S” on the front of their ID card.

The ID card will include the following information:

• Paper and electronic claims submission addresses
• TPA’s telephone number and address(es) for inquiries about eligibility, benefits, claim status, and payment 

Option 2: Coverage details on CignaforHCP.com

When you perform a search of your patient on CignaforHCP.com, the “Coverage Details” screen will indicate if the patient’s plan is a TPA and include the TPA name and phone number. 

EmblemHealth April 2023 Provider Newsletter

EmblemHealth shared their April 2023 provider newsletter. Highlights include:

• Key updates to preauthorization lists
• Lab venipuncture policy update
• Provider portal videos and training guidance

The End of the COVID-19 PHE: What You Need to Know

Medicare Fee-For-Service telehealth changes effective 5/12/23:

• Prescribers will be required to see a patient face-to-face before prescribing controlled substances
• If performing telehealth at home, practitioner will be required to report their home address on the Medicare enrollment site

Telehealth changes effective 8/9/23 — All Payers

• Telehealth platforms must be HIPAA compliant
• HHS is providing a 90-day grace period for providers to come into HIPAA compliance with regards to telehealth. The grace period is in effect May 12, 2023 and will expire on August 9, 2023.

Medicare Fee-For-Service telehealth flexibilities extended through 12/31/24:

• Medicare patients will continue to be able to receive telehealth in their homes and regardless of geographic location
• Medicare patients can continue to receive audio-only telehealth visits (eligible audio-only CPT/HCPCS codes)
• The expanded list of practitioners continues and includes physical and occupational therapists, speech language pathologists, and audiologists

Medicare Fee-For-Service Telehealth payment rates change as of 1/1/24:

Currently providers receive payment as if services had been provided in-person (at the non-facility based payment rate in offices); this will end on 12/31/23.

Beginning 1/1/24, practitioner services will be paid at the facility rates for telehealth office-based services (approximately 25-30% less than the in-person office-based rates).

To learn more refer to this CMS fact sheet

Welcome to MSHP!

We'd like to extend a warm welcome to the newest member of our Clinically Integrated Network:

Shari Leipzig, MD

Obstetrics & Gynecology

Shari Leipzig, MD

New York, NY