Tagged with Provider Contracting and Enrollment
Effective April 1, UnitedHealthcare (UHC) will require care providers to submit a notification for injectable chemotherapy for members located in Wisconsin when it is administrated in an outpatient setting for UHC Medicare Advantage (MA) members with a cancer diagnosis.
As part of an ongoing effort to reform the state’s Medicaid program and ensure the purchase of cost–effective, high quality healthcare, and better outcomes for its beneficiaries, New York has reduced the number of eligible breast cancer surgery facilities for Medicaid recipients.
Humana has released several claims processing edits, including updates to Outpatient Prospective Payment System (OPPS), Modifiers 96 and 97, HCPCS Drugs & Biologicals, and other policies.
CMS has published a decision memo finalizing its proposal to cover MRI scans for Medicare beneficiaries with implantable cardiac devices such as pacemakers and cardioverter defibrillators.
The American Medical Association (AMA) and the American Society of Addiction Medicine (ASAM) have announced plans to pilot test a model that includes medications combined with psychosocial support.
CMS has released an updated version of the Medicare Part D opioid prescribing mapping tool.
CMS and the Department of Health and Human Services (HHS), on April 9, issued the Notice of Benefits and Payment Parameters (NBPP) final rule for plan year 2019, updating policies and standards applying to qualified health plans (QHPs) offered on Affordable Care Act (ACA) Exchanges.
The Governor of Maryland has signed legislation which seeks to stabilize the state’s insurance market for individuals and hold down expected rate increases.
Illinois Medicaid has transferred the healthcare coverage of approximately 550,000 residents to the state managed care plan, HealthChoice Illinois, and will soon see their health care handled by managed care organizations (MCO).
The Florida Department of Health (DOH) has announced plans to privatize management of the Children’s Medical Services Managed Care plan (CMS plan).
CMS has announced the deadline extension for providers planning to submit an expression of interest (EOI) for the Low Volume Appeals (LVA) Initiative.
CMS has expanded its definition of “primarily health related” benefits which carriers are allowed to include in their Medicare Advantage (MA) policies.
CMS will remove the prior authorization (PA) requirement for certain types of medical equipment that no longer meet standards set forth in a 2015 final rule.
A recent analysis by the Center for Community Solutions finds that Ohio’s proposed Medicaid eligibility requirements would cost the state $378 million over five years in added administrative costs for county governments.
UnitedHealth Group has announced plans to introduce a new payment policy intended to reduce its emergency department claims cost.
UnitedHealthcare (UHC) has made changes to its reimbursement policy for Laboratory Services affecting reference laboratories and non-reference laboratory physicians.
CMS has issued a reminder to providers regarding overpayment and correct billing for many stem cell transplants incorrectly.
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).
Humana has released a number new pharmacy coverage policies, as well as significant revisions to its medical coverage policies.
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).