Category: Payer Updates

Posted in BCBS Empire NY, NY Providers, Payer Updates, Training

Anthem BCBS: 32BJ fund new TPA and cards

Posted on by KR2Medical Billing

As the new year starts so do the change of theember ID changes and or group numbers.

Is your provider office aware of these changes?

Please note that for any 32BJ members there is a new TPA, group#, member ID, and cards.

Please note the new ID:

Effective Jan 1,2026- new members ID prefix BJVBJ.

Image via Anthem BCBS

For OON probiders- please make sure to submit your claims directly to the TPA- WebTPA.

Find this type of information useful? Follow my blog!

Posted in #aetna, #Medicare, #reimbursement, Payer Updates, Payers and CPT reinbursement, Training

Are you leaving revenue on the table?

Posted on by KR2Medical Billing

Aetna update!

Is your practice compliant?

Are you appending proper modifiers to radiology, diagnostic services and surgery services- when billed with the following ICD-10 codes: Z53.01, Z53.09, Z53.1, Z53.20, Z53.21, Z53.29, Z53.8, Z53.9?

As per Aetna- if the following modifiers are not billed on the claims for the above services with above named ICD-10 codes- the claims will be denied.

This change will take affect April 1,2026 and apply to commercial and Medicare plans.

Find this type of information useful? Follow my blog for more!

Posted in #Medicareadvantage, #reimbursement, #unitedhealthcare, Payer Updates, Prior Authorization Insurance Carrier Updates

UHC Medicare Advantage Plans: DME changes in certain States

Posted on by KR2Medical Billing

For any DOS April 1st 2026 and thereafter the new company that will manage DME ordering and fulfillment will be Synergy Health.

This change will apply to Medicare Advantage Plans in certain states:

Individual HMO and PPO plans:

Via UHC website

Chronic Special Needs Plans (C-SNP)

Via UHC website

Dual Special Needs Plans (D-SNP):

  • North Dakota
  • South Dakota
  • West Virginia

DME providers would need to join Synapse Health network. Synapse will contact you, however you can also reach out to them via email: JoinOurNetwork@synapsehealth.com

To which DMEs does this change apply?

  • Diabetic supplies
  • Enteral
  • Home ambulatory
  • Hospital beds
  • Insulin therapy
  • Mobility aids 
  • Negative pressure wound therapy
  • Ostomy
  • Oxygen
  • Respiratory
  • Respiratory vest
  • Sleep
  • Urological
  • Ventilators
  • Wheelchairs

The DMEs that this change does not apply to?

  • Bone growth stimulators
  • Cancer treatment
  • Cardiac defibrillators
  • Complex rehab
  • Optune device
  • Oral devices
  • Orthotics
  • Parenteral nutrition, vision, and hearing
  • Prosthetics

Authorizations:

Providers would need to request an auth from Synapse Health for DOS of April 1st 2026 and there after, via their portal https://connect.synapsehealth.com/authorization/login

As a provider you can also go on their web to request a personalized training http://www.synapsehealth.com/welcome

Which plans are no affected by this change? Medicare Advantage-

Institutional Special Needs Plans (I-SNP)
Institutional Equivalent Special Needs Plans (IE-SNPs) 
Group retiree plans

Find this type of content useful? Follow my blog for more payer updates: medical coding, billing, reimbursement, prior auth.