Author: KR2Medical Billing

My name is Kate Patskovska, CPB. I am an Independent Medical Biller CPB (AAPC), AAPV Approved Instructor; and an owner of KR2 Medical Billing. I create educational material including blogs, presentations that focus on topics of medical billing, medical coding and reimbursement in healthcare.
Posted in #unitedhealthcare, Payers and CPT reinbursement, Pharmacy (Various Insurance Payers)

UHC Medicaid: Idaho: diabetic DME coverage change-benefit

Posted on by KR2Medical Billing

Starting for DOS 4/1/26 and thereafter the following codes will be covered through the patient pharmacy benefit and no longer will be covered under patient medical benefit.

Images via UHC website

For DOS 1/1/26 through 3/1/26- providers can still bill either through medical benefit or pharmacy benefit.

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Posted in BCBS Empire NY, NY Providers, Payer Updates, Training

Anthem BCBS: 32BJ fund new TPA and cards

Posted on by KR2Medical Billing

As the new year starts so do the change of theember ID changes and or group numbers.

Is your provider office aware of these changes?

Please note that for any 32BJ members there is a new TPA, group#, member ID, and cards.

Please note the new ID:

Effective Jan 1,2026- new members ID prefix BJVBJ.

Image via Anthem BCBS

For OON probiders- please make sure to submit your claims directly to the TPA- WebTPA.

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Posted in #aetna, #Medicare, #reimbursement, Payer Updates, Payers and CPT reinbursement, Training

Are you leaving revenue on the table?

Posted on by KR2Medical Billing

Aetna update!

Is your practice compliant?

Are you appending proper modifiers to radiology, diagnostic services and surgery services- when billed with the following ICD-10 codes: Z53.01, Z53.09, Z53.1, Z53.20, Z53.21, Z53.29, Z53.8, Z53.9?

As per Aetna- if the following modifiers are not billed on the claims for the above services with above named ICD-10 codes- the claims will be denied.

This change will take affect April 1,2026 and apply to commercial and Medicare plans.

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