Do you or your office reports social determinants and accept Aetna Better Health members? Great news! Now according to an update sent to the physicians, the insurance plan will reimburse for certain Z codes that correspond to certain social determinants of health.
Some of these Social Determinants of Health include (not all included):
• Assistance reapplying for Medicaid benefits • Transportation: ModivCare • Cleaning: Pest control, carpet cleaning, house cleaning • Housing Specialist: assist with housing searches, voucher applications, transitioning from institution to community • Member Advocates: assist with coordinating and access to community resources • In-office care management support for provider or specialist visits • Peer support specialist • Disease management education • Smoking cessation support services
The Z codes will be reimbursed when they are billed with code: G9919
Starting 01/01/2023 Oxford will add and remove certain codes that require prior authorizations (commercial line of business). According the Oxford this change helps align their processes with evidence-based clinical guidelines. Some of the new codes that will be added are: For a full list of new codes that will be added to the list of […]
This change applies to members that have Individual and Family (Exchange Plans)1 and are on diabetes medication. As of September 1,2022 and thereafter UHC will no longer cover diabetes medications: Invokana® and Invokamet® Current Medication Coverage: UHC will cover these medications for patients that are currently have an authorization, until Dec 31,2022. New covered medicationsEffective […]
This policy update applies to Commercial and Exchange EmblemHealth Plans and ConnectiCare Plans. This policy applies to ongoing Infusion maintenance treatment for members that are 21 years and older. Starting for DOS August 1, 2022 and thereafter, EmblemHealth will start to review ongoing infusion treatments for Site of Services (Place of service). Preferred POS locations: […]
Are you an Aetna Medicare Advantage participating provider and had issues with your post-service appeals? If your answer is yes, it is because as of Jan 1, 2022 there is a new address where the providers need to submit those appeals to.
There is also a NEW FORM that the provider needs to fill out.
Where to find the new form?
You can find this form, which is called the Medicare Provider Complaint and Appeal Request Form, by going to the forms for health care professionals page and scrolling to the “Dispute and appeals” drop-down menu.
The New form should be sent to the address below:
Medicare Provider Appeals PO Box 14835 Lexington, KY 40512 Fax: 1-860-900-7995
OLD ADDRESS IS NO LONGER VIABLE:
Provider Resolution Team PO Box 14020 Lexington, KY 40512 Fax: 1-800-624-0756
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According to Aetna June 2022 provider newsletter- Aetna will NO Longer pay for the mid level staff: nurse practitioners, physician assistants, certified nurse midwives and clinical nurse specialists, at 100%, if they are performing the following codes:
G0402- Long description: Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment Short description: Initial preventive exam
G0438- Long description: Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit
Short description: Ppps, initial visit
G0439- Long description: Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit
Short description: Ppps, subseq visit
Note to Washington State providers: Your effective date for changes described in this article will be communicated following regulatory review.