Category: NY Providers

Find Medical Billing and Coding guidance for any Providers that operate in NY State

Posted in #unitedhealthcare, NY Providers, Payer Updates, Training

UHC NY Community Plan Referral requirement change-effective immediately

Posted on by KR2Medical Billing

As per UniteHealthCare- NY community Plan -members will no longer require referrals to see specialists (most specialties).

This change is made to help Primary Care Physicians with reducing administrative burden and make it easier for the members to see some specialists.

The specialists that do or do not require a referral still need to be In Network with UHC NY Community Plan.

Below are the specialties that still require the referral. The members will need to contact their PCP office in order to obtain a referral and ensure that the Specialist will get reimbursed for the services provided.

  • Allergy and immunology
  • Dermatology
  • Endocrinology
  • Gastroenterology
  • General surgery
  • Neurological surgery
  • Orthopedic surgery
  • Otolaryngology
  • Physical medicine and rehabilitation/physiatry
  • Plastic surgery
  • Podiatry
  • Pulmonary medicine
  • Sports medicine
  • Urology
  • Vascular surgery

I am a provider, where should I go in order to request a referral?

Providers can request a referral on the UHC provider portal (UHCprovider.com ) Providers need to sign into the portal.

I am a provider and still have questions regarding the referral process, where should I go to find more infomation?

Provider can visit interactive guide in order to get more information regarding referral process.

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#NYMedicaid, #UHCCommunityPlan #UHC #referrals #specialists

Posted in BCBS (Various States), NY Providers, Training, Updates

HEDIS Measure: Update Colorectal Cancer Screening for 2022

Posted on by KR2Medical Billing

Are you a primary care physician and is reporting HEDIS measures? Then this following blog post is for you.

In this blog post we will discuss the changes/updates that NCQA just released for HEDIS Colorectal Cancer Screening Measure.

Measure Description: Measures the percentage of members 45 to 75 years of age who had appropriate screening for rectal cancer. The Medicaid product was added to the administrative data collection method for this measure and the age range was changed to 45 to 75 years of age.

In order to meet this measure your patients need to fall in ANY of the following criteria:

  • Fecal occult blood test during the measurement year
  • Flexible sigmoidoscopy during the measurement year or the four years prior to the measurement year
  • Colonoscopy during the measurement year or the nine years prior to the measurement year
  • CT colonography during the measurement year or the four years prior to the measurement year
  • Stool DNA (sDNA) with FIT test during the measurement year or the two years prior to the measurement year

If you would like to report this measure via Electronic Clinical Data Reporting system you will need to select: Colorectal Cancer Screening (COL-E).

Reminder: please make sure to document all of needed information in the patient medical records.

#HEDIS #Cancer #primarycare #physicians #NCQA

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Posted in BCBS Empire NY, NY Providers, Payers and CPT reinbursement, Pharmacy (Various Insurance Payers), Training, Updates

BCBS Empire NY Medicaid: Reimbursement for Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Counseling program

Posted on by KR2Medical Billing

If you are a pediatrician that provides vaccination counseling for patients under 18 years of age and younger then this blog post is for you!

The following is a clarification on the proper coding and billing for or provider reimbursement for pediatric vaccine counseling visits as part of the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program.

This reimbursement policy applies to Medicaid members (Empire BCBS).

Note: Vaccine counseling visits align with the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP)

The following is the correct CPT code with the ICD-10 code that the providers would use in order to get proper reimbursement.

 CPT® codeFeeNotes
Claims basedCPT 99401DX: Z71.85$12.50A provider submitting professional claims should bill Current Procedure Terminology (CPT) code 99401 for preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure) for reimbursement for childhood vaccine counseling. A minimum of eight minutes is required and recommended for ages 18 years or younger.
via Empire BCBS Medicaid Updates

Documentation requirements: In order to get paid for the above mentioned code, the providers need to document the following in either the medical record or a pharmacy record.

  • CPT 99402: Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure).
  • Providers should bill CPT 99402 with ICD-10 code Z71.85.
  • Confirm vaccination status in the New York State Immunization Information System (NYSIIS) or City Immunization Registry (CIR), whenever possible.
  • Providers are encouraged to counsel all members who have not already have an appointment scheduled to receive the vaccine dose for which they are being counseled.
  • For more information, visit https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html

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