According to EmblemHealth-for self funded plans: Local 389 Health and Welfare fund- for the DOS 9/1/23 and thereafter have a new timely filling date for submitting claims. The new date is 90 days after the services were rendered.
This new time frame applies to In network and Out of Network providers.
Types of claims: professional, facility and other provider types
Please note that this change DOES NOT APPLY to the other ASOs (Administrative Service Organizations).
The following is still in affect:
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Previous Blog Posts:
Aetna trauma response reimbursement
The following update applies to Aetna Commercial and Medicare plans. What is changing? In order to get reimbursement for trauma response services Aetna will require an accompanying HCPCS code with the cooresponding Rev codes A qualifying ambulance transport service on the same DOS Rev codes affected: 0681: Trauma Response, Level I0682: Trauma Response, Level II0683:…
UHC: new vascular embolization criteria/policy
Are you a provider that accepts members with the following plans: UHC commercial, Medicare Advantage, and some UHC plans? Then this blog post is for you! What is changing? For any dos 12/1/26 and thereafter UHC will require a prior authorization/ medical necessity review for code 37242 UHC will remove the site of services requirenment…
UHC: GI endoscopy advance notification and SOS update
Are you a provider that accepts UHC commercial or Oxford NY, and CT members? Then this blog post is for you. What is changing? As per UHC- effective on DOS 10/1/26 and there after an advance notice will no longer be required for GI procedures As per UHC- effective on DOS 10/1/26 and thereafter the…
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