According to EmblemHealth- effective 01/01/2019- “Magellan Health Inc will no longer provide utilization management for injectable drugs”.
Until further notice the prior authorization requests will be sent over to EmblemHealth DIRECTLY either via web: https://emblem.promptpa.com or via fax: 877-243-4812 or via phone: 888-447-0295
Last week I had a conversation with one of employees that works in the OBGYN office.
She said: ” Kate, I have a very large pile of denials on my desk. They all have to do with Vitamin D testing/screening for my Aetna patients. In the previous years, our office had no problem with testing women for Vitamin D. Now I have no idea what is going on? Is there anyway you can help me out?”
I said: “Sure, let me look in to it and I will let you know by tomorrow.”
Later that day I find out the following:
According to Aetna the Vitamin D assay testing is considered to be experimental and investigational for routine preventative screenings.
The next day I tell that employee what I found out.
She says: ” Wow. None of the people in my billing department had any answer for me! Thank you very much. I will pass this information on to both my clinical staff and my billing department. You are a big help!”
After 6 months!!!! Yes, 6 months of fighting with NY DOH, regarding this provider NYSIIS transmission. Finally! SUCCESS!!!
Year 2 of Medicaid EHR Incentive program (CMS Medicaid Promoting Interoperability Program) successfully paid : $8,500!!!
KR2 Medical Billing 