Aetna to Reactivate Billing Modifiers 25, 59 and X series
Aetna has announced they will reactivate edits when a CPT code on the claim form contains billing modifiers 25, 59 or X series (XE, XP, XS, XU). This reactivation will apply to the states of I hope you found this article helpful. Thank you for being a Gold Member!
UnitedHealthcare Community Plan of New York
UnitedHealthcare has announced a major change in what CPT codes will be reimbursed for outpatient physical and occupational therapy services for their UnitedHealthcare Community Plan of New York as well as the following plans in the state of New York: UnitedHealthcare Community Plan for Families (Medicaid) UnitedHealthcare Community Plan Wellness 4 Me (HARP) UnitedHealthcare Community Plan Essential Plan (EP) Products. This update will affect CPT Codes for physical and occupational therapy and for evaluation management. All other CPT codes for physical and occupational therapy services will be considered non-covered. The effective date of the changes for UHC Community Plan of New York is I
New York Mandates Insurances Pay for Telehealth Services
On March 3, 2020, New York State Department of Financial Services issued Insurance Circular Letter No. 3 (2020) to All Insurers Authorized to Write Accident and Health Insurance in New York State, Article 43 Corporations, Health Maintenance Organizations, Student Health Plans Certified Pursuant to Insurance Law § 1124, and Municipal Cooperative Health Benefit Plans. The letter goes on to state the following: “Issuers are reminded that Insurance Law §§ 3217-h and 4306-g and Public Health Law § 4406-g prohibit issuers from excluding a service that is otherwise covered under a comprehensive health insurance policy or contract because the service is
AIM Specialty Health November 2019 Updates
If you submit claims to Anthem Blue Cross, significant changes are occurring beginning with dates of service on and after November 1, 2019. AIM Specialty Health has announced they will relaunch the AIM Rehabilitative program (i.e. prior authorization) for Anthem’s Commercial Membership on November 1, 2019 for the following states: I hope you found this article helpful. Thank you for being a Gold Member!
UHC Community Plan Adds 3 States to Prior Authorization
UnitedHealthcare (UHC) Community Plan is adding 3 states (in addition to the 4 previously announced) that will require prior authorization prior to initiating physical, occupational and/or speech therapy services. In addition, UHC Community Plan is adding site of service medical necessity reviews for all speech, occupational and physical therapy services provided in a hospital outpatient setting in 2 of the 3 states. The new impacted states are
UnitedHealthcare Community Plan Implements Prior Authorization for Therapy
UnitedHealthcare Community Plan has announced they will implement prior authorization for outpatient physical, occupational and speech therapy services in select states beginning as early with dates of service on and after August 1, 2019. In addition, UnitedHealthcare Community Plan has announced they will be conducting site of service medical necessity reviews for all speech, occupational and physical therapy services in select states. Effective with dates of service on and after August 1, 2019, the following states will be required to obtain prior authorization before implementing outpatient physical, occupational and/or speech therapy services:
Anthem BCBS to Require Preauthorization for Outpatient Therapy
Effective July 1, 2019, Anthem Blue Cross patients in several states will require preauthorization to receive outpatient physical, occupational and speech therapy services. This will be true not only for new patients beginning therapy on or after July 1, 2019, but also for current Anthem patients who are being seen now and will continue to be seen for therapy on or after July 1, 2019. The states where prior authorization will be required effective for dates of service on and after July 1, 2019 are:
AIM Specialty Health
Anthem Blue Cross-Blue Shield has announced they are initiating a new utilization management (UM) program with AIM Specialty Health, a subsidiary of Anthem beginning in 5 states. This program will begin on March 1, 2019 in the states of Indiana, Louisiana, New York and Wisconsin and March 25, 2019 in California. This new UM program will impact all commercial enrollees receiving outpatient physical, occupational and speech therapy services. AIM has already completed 3 webinars and has 2 more 10-hour webinars planned. The next webinar is February 26, 2019 at 3:00pm ET and the last webinar is on March 20, 2019