Volume 01 | November 4, 2020
Your Guide to Payor News & Updates
Action Items- We Need Your Help!
Anthem/BCBS- Call to Action

We sent out a communication recently on an opportunity for practices to voice their concerns with Anthem/BCBS.

The Georgia MGMA (GMGMA) and the Medical Association of Georgia (MAG) are asking practices to voice their concerns and frustration with Anthem/BCBS to the Georgia Department of Insurance.

The GA Department of Insurance has initiated a Market Conduct Examination of Anthem/BCBS to investigate how their actions influence Consumer Behavior. The GMGMA is expected to contribute to this investigation by gathering and sharing feedback from practice’s experiences with Anthem/BCBS.

Please refer to the GMGMA Action Letter, Sample Letter and Claims Spreadsheet for details on the type of information to send.

Please note the deadline is Friday, November 6th!

For questions, please contact the GMGMA representatives below:

Kelly Ladd: kelly.ladd@pimapc.com
Karlene Dittrich: medrevenue@bellsouth.net
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
Humana has resolved the flu and well check claim’s issues.

Humana is asking that practice’s resubmit the outstanding claims for reprocessing. Please be sure to track the outcomes of the reprocessed claims.

Our Humana representative can create a project after we have submitted the claims for reprocessing.
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 do not appeal claims without exhausting all other avenues to get a resolution. Once the appeal process is started, our payor representatives and myself are locked out of the process and are unable to assist with claims issues.

Tip 2:

We are not in-network with all plans offered by our contracted payors.

Example 1: We have a contract with UHC but we are not contracted with the Navigator plans.

Example 2: We have a Cigna contract but are not contracted with some mini-networks.

Example 3: Unions can create their own network of providers.

Please remember to check all benefits and reach out to the payors or myself when in doubt.
Resources For You