Tagged with Aetna
As of June 1, Aetna will expand its clinical review program and implement pre-approval changes for members in Indiana (IN), Illinois (IL) and Tennessee (TN).
Effective September 1, Aetna will implement changes to its clinical payment and coding policy for several services and procedures, and will also implement several changes to its CPT® codes assigned to Enhanced Groupings (AEG) and/or Coventry Enhanced Groupings (CEG).
Aetna has made changes to its precertification list for certain home health care services for Medicare Advantage members
Aetna has released the most recent Current Procedural Terminology® (CPT®) codes added to Aetna Enhanced Grouper (AEG) and/or Coventry Enhanced Grouper (CEG) assignments.
Effective July 1, Aetna will update its pharmacy plan drug lists. These changes will affect all Pharmacy Management drug lists, precertification, quantity limits and step-therapy programs.
Effective July 1, Aetna will implement changes to its clinical payment and coding policies as well as several changes to its National Precertification List (NPL).
Aetna has issued a notice reminding providers and billing professionals that Medicare beneficiaries under the Qualified Medicare Beneficiary (QMB) program should not be billed for cost sharing (balanced billing).
Aetna has made adjustments to five clinical payment, coding policies that will become effective on March 1st.
Aetna has released updated clinical, payment and coding policies, including multiple procedure reduction for diagnostic cardiology, diagnostic ophthalmology, and therapeutic services.
The New York Department of Financial Services has released 2018 health insurance rates for the state’s individual and small group markets, including rates for the NY State of Health, New York’s official health plan marketplace – ranging from 4.4% for Excellus to 31.5%.
The Illinois Department of Healthcare and Family Services has announced the names of the insurers that will take part in the Governor’s proposed overhaul of the state’s Medicaid Managed Care program.
For the first time since 1990, the Illinois Department of Insurance will conduct a broad market examination of Blue Cross and Blue Shield of Illinois to see how the insurer treats its customers in compliance with consumer protection regulations.
UnitedHealth Group has announced plans to shut down its subsidiary insurance startup which offered unlimited primary and behavioral care at no charge.
Aetna has announced plans completely withdraw from the ACA insurance exchanges for 2018, citing financial losses as the deciding factor, specifically its individual commercial products lost nearly $700 million between 2014 and 2016 and could lose another $200 million this year.
Applicable to the technical component, claims billed with modifier FX to indicate X-ray imaging services were provided using film reduces will be subject to a 20% reduction.
Two separate studies investigated why consumers respond to high-deductible plans by using less healthcare services, which in turn leads to a decrease in doctor visits and clinical laboratory test orders.
The U.S. Justice Department recently disclosed that there will be an investigation into four more major health insurers as part of a False Claims Act lawsuit filed against UnitedHealth Group in 2011.
Humana has announced its plans to cease sales of individual health insurance plans through the ACA’s exchanges by 2018, potentially leaving more than 150,000 customers without a carrier.
A new study reveals insurers with the largest share of local markets can negotiate lower prices for physician office visits.
A federal judge ruled against Aetna’s proposed acquisition of Humana, maintaining the Justice Department’s decision that the multi-billion deal would be anticompetitive and raise prices for consumers.