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 #Medicareadvantage, MVP (NY/VT) Insurance Payer, Prior Authorization Insurance Carrier Updates, Updates

MVP to end its relationship with naviHealth, Inc

Posted on by KR2Medical Billing

Currently naviHealth, Inc handles Utilization and Case/Care Management for post-acute services—including Skilled Nursing Facility (SNF), Inpatient Rehabilitation Facility (IRF), and Home Health—for MVP Medicare Advantage, DualAccess, and DualAccess Complete Members.

However, MVP and naviHealth, Inc will end their contract as of Dec 31st 2025.

Starting on Jan 1,2025 MVP will process these requests in house.

More information to come in Nov 2025.

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Posted in MVP (NY/VT) Insurance Payer, NY Medicaid EHR incentive program, NY Providers, Payers and CPT reinbursement, Updates

MVP postpartum program incentive payments: NY providers!

Posted on by KR2Medical Billing

Are you any of these following providers in NY?

OB/GYN Family Medicine Certified Nurse Mid-wives Nurse Practitioner – Family Health

Then this blog post is for you!

NY DOH established an additional payment (to global OBGYN bundled payment) for providers that complete a person-centered postpartum visit— including a depression screening—within 12 weeks of delivery, as per ACOG/AAP guidelines.

In order to qualify for this additional payment the postpartum services need to be related to deliveries that occurred from July 1, 2024, through March 31, 2025.

Coding that qualify for this program are:CPT II Code 59430 or 0503F

Please bill these codes with $0

This program only applies to Managed Medicaid Care Plan type.

The additional payment amount is $125.

The payments are maid quaterly basis.

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Posted in #reimbursement, BCBS (Various States), BCBS Empire NY, NY Providers, Pharmacy (Various Insurance Payers)

BcBS HighMark NY: coverage for COVID-19 vaccine

Posted on by KR2Medical Billing

According to Highmark BCBS- the COVID-19 vaccine will be covered with out any pocket costs through 2025-2026.

This currently only applies to Managed Medicaid, Child Health Plus, Essential and HARP plan types.

The vaccine will still be part of standard preventive care benefits, COVID‑19 vaccines are covered for all members older than 6 months of age.

Members are encouraged to contact their primary care or pharmacy for vaccine availability.

Highmark will partner with Wellpoint companies to administer this benefit.

As per Highmark-Wellpoint Insurance Services, an independent company, administers utilization management services for Highmark Blue Cross Blue Shield’s managed Medicaid.
Wellpoint Partnership Plan, LLC provides management services for Highmark Blue Cross Blue Shield’s managed Medicaid.

Certain sef-insured plans have special vaccine coverage and should check their benefits coverage for more info.

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