From Humana:
The Centers for Medicare & Medicaid Services (CMS) published the 2021 Medicare Physician Fee Schedule (PFS) final rule on Dec. 1, 2020, expanding Medicare-covered telehealth services to similar services already covered under the Medicare program. Please note:
Priority Health has identified a large-scale scam in the market affecting commercial and Medicare members, including Priority Health members. The scam has also impacted other insurance carriers and providers in and outside of Michigan.
What you need to know
Be on alert for any prescriptions or certificates of medical necessity (CMN) received through fax from pharmacies or suppliers, indicating the patient has requested the medication or supplies.
Examples of fraudulent requests:
An Update from Priority Health:
As COVID-19 vaccines begin to be more widely distributed in our communities, we’re sharing information on billing and reimbursement for the vaccines and administration.
You should not collect any member cost share, such as copays, for first or second doses of COVID-19 vaccines or administration of the vaccine.
UnitedHealthcare is extending the temporary suspension of select prior authorization requirements for in-network hospitals and in-network Skilled Nursing Facilities (SNFs) nationwide through Jan. 31, 2021. The temporary suspensions are effective from Dec. 18, 2020 through Jan. 31, 2021. (They were previously set to end on Jan. 8, 2021.)
Humana has provided us the attached Power Point presentation regarding their NEW authorization process -- Cohere. This process began on 1/1/2021.
Please read the details in this attachment about how to submit a request, the clnical review process, peer to peer consults, and many more details regarding this new authorization system.
Please read the attachment for the latest news from Priority Health!
In addition from Priority Health:
The 2021 PCP Incentive Program (PIP) manual is finalized and available for download. Visit 2021 PCP Incentive Program Manual (priorityhealth.com) to view.
2021 new measures
Please read the informational attachments for the latest from United Healthcare on COVID-19, Tele-health, The Administrative Guide for 2021, and much more in 2021.
Also, please connect with this link to sign up for future emails from UHC: Please visit: UHCprovider.com/subscribe to sign up!
Since the COVID-19 pandemic began, CIGNA has delivered timely accommodations to providers and customers, and ensured that customers have continued access to COVID-19 screening, testing, and treatment in safe settings.
Please read the attachment for details on vaccines, treatments and extended coverage accommodations.
COVID-19 vaccines
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