Category: In The Know Series

Posted in In The Know Series, Insurance, Updates

UnitedHealthCare Commercial Plans: Pharmacy coverage for Taltz and Siliq coverage for 2020.

Posted on by KR2Medical Billing

Pharmacy Benefit change for UnitedHealthCare Commercial Plans– starting 01/01/2020-biologics Taltz and Siliq will no longer be COVERED (where state law allows) , for the UnitedHealthCare Commercial Plans.

The other preferred/covered biologics are:

Humira

Cimzia

Cosentyx

Simponi

Skyrizi

Stelara

Tremfya

 

*Please check out the pharmacy criteria for the coverage of these above mentioned biologics.

 

** The pharmacy WILL NOT automatically substitute Taltz or Siliq for the covered medications. Provider will need to write a NEW prescription and send it over to the pharmacy (to help reduce the out of pocket cost, for the patients).

Posted in In The Know Series, Insurance, Updates

Does your office see Oxford Commercial Plan Members? – new change for 2020 is coming!

Posted on by KR2Medical Billing

New* For 2020-UnitedHealthCare announced that Oxford (Commercial Plan) members will start to receive new benefit cards. There will be several changes.

These changes as follows:

  1. The new ID number will be 11-Digit ID
  2. The Group number will ONLY contain numbers
  3. The UHCprovider. com will be on the back of the cards.

The Payer ID will NOT CHANGE it will remain as 06111

*You will be able to use the UHCprovider.com for secure member transactions, including checking eligibility, benefits and claims.

Posted in In The Know Series, Insurance, Training

Emblem GHI PPO (commercial members)-new member IDs for 2020

Posted on by KR2Medical Billing

Starting, in the beginning of 2020, Emblem GHI PPO commercial members will receive new ID numbers and new ID cards.

The following changes will take place:

  1. New ID numbers will start with a letter K
  2. New ID numbers will have only 8 number spaces
  3. The last 2 digit numbers will reflect the # for each dependent (eg. 01, 02, 03)
  4. Will be subject to the radiation therapy and cardiology imaging (eviCore) programs
  5. Will be subject to HIP radiology and self referral payment policy.

GHI PPO (City of New York members) are not affected by this change.

 Medicare PPO Members who are on Medicare Choice PPO network will have the new ID change but will not be subject to eviCore Programs.

The process is expected to continue through the end of 2020.