Currently, UnitedHealthCare has updated their log in process to LINK-by adding an Authentication Step.
Please be advised that this process needs to be completed by March 27,2020
This step will require you to receive an authentication code by via email or text. According to UHC, this is intended to be as a one-step process. So, you will not need to repeat it, unless you are signing on to the LINK on another computer.
The box will pop up, before each log in. However, you can click on a check box to skip that step, as long as you are using the same device to log in to LINK.
For Step By step instructions, please click on the link below.
Accredo Convenient Care Program to start on 04/01/2020
Things to consider:
-Accredo’s Convenient Care Program is responsible for in-home fusion treatment for EmblemHealth members
-This update applies ONLY to members that are 21 years and older AND have an EmblemHealth Commercial Plan Coverage
-Coverage is for infusion medications that can be provided for patients in their homes or AIS (Ambulatory Infusion Suites/POS 12 or physicians office /POS 11
–After 04/01/2020-members do have an option to request ONE-TIME-ONLY refill of the specialty medicine at their CURRENT PROVIDER, if needed (check with customer service if Prior Auth would be required, if your Provider is in POS 19 or POS 22)
-Prior authorization is required in order to receive treatment in outpatient hospital setting. IF member is using Doctors Office of Campus POS19 or POS22 w/o an authorization, member will be responsible for the FULL AMOUNT OF the drug cost and treatment.
Transition Process:
1. An Accredo Representative will reach out to prescriber for a NEW prescription
2. Once a valid Prescription is received the Accredo Rep then will reach out to the member and schedule a delivery of medicine.
In Network Ambulatory Infusion Suites:
-Coram and Option Care infusion vendors have AIS throughout the country
Please contact your nearest Coram or Option Care location for more information
List of Specialty medications:
BIVIGAM
HIZENTRA
CARIMUNE NF
HYQVIA
CUVITRU
INFLECTRA
FLEBOGAMMA 5&10%
OCTAGAM
GAMMAGARD LIQUID
PANZYGA
GAMMAGARD S-D
PRIVIGEN
GAMMAKED
REMICADE
GAMMAPLEX
RENFLEXIS
GAMUNEX-C
*Expeptions:
In order for the member to start or to continue the treatment in POS 19 or POS22 – the provider needs to submit clinical rationale and documentation for review.
AND
Member must to meet ONE of the following criteria:
-Pediatric Patient (under 21 years of age)
-Documented history of severe reaction, which is defined as anaphylactic reaction, to this medication or any constituent of it
-Known cardiac condition (e.g. symptomatic cardiac arrhythmias) or pulmonary condition (e.g. significant respiratory disease, serious obstructive airway disease, %FVC less or equal to 40%) that may increase a risk of an adverse reaction
-Documented intolerance to this medication requiring constant telemetry monitoring of vitals
-Unstable renal function which decreases the ability to respond to fluids
-Difficult of Unstable vascular access
-Unsafe home environment
-Acute mental status changes or cognitive conditions that impact the safety of infusion therapy
-No access to emergency services
Submitting an exception or request help to locate an approved home infusion vendor or AIS (ambulatory infusion suites):
There are 374 changes to the HCPCS codes for the year of 2019. Some of them had to do with increasing number of new injectable medications/drugs that have saturated the market.
If you are a provider that treats patients with Fasenra, then up until now you have been probably using J3490 – unlisted cpt code, to bill for the mediction itself.
However, as of January 1,2019 for any dates of services on that day or going forward the new J code is assigned to Fasenra:
IF YOU WOULD LIKE TO LEARN MORE ABOUT COVERAGE OF FASENRA BIOLOGICS, BILLING PROPER INJECTION CODES, REQUESTING PRIOR AUTHORIZATIONS, PLEASE FEEL FREE TO REGISTER FOR MY NEW ON DEMAND WEBINAR BELOW:
KR2 Medical Billing 