Tag: #aetna

Posted in #aetna, #Medicare, #Medicareadvantage, Payers and CPT reinbursement

Aetna Commercial and Medicare Plans: Payment for Occupational Therapy/Physical Therapy Assistants

Posted on by KR2Medical Billing

As per Aetna Updates: starting December 1,2023 the Occupational Therapy Assistants and Physical Therapy Assistants will get their own reimbursement for performed services.

Reimbursement amount: 85% of Allowed amount.

Please append the following modifiers to the services that are performed by the PTAs and OTAs:

CO-occupational therapy services performed in part or as a whole by an Occupational Therapy Assistant

CQ-physical therapy services performed in part or as a whole by a Physical Therapy Assistant.

This change applies to Medicare and Commercial plan types.

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UHC to remove prior auth for some radiology and cardiology tests.

Starting Jan 1, 2026 certain nuclear imaging tests, OBGYN ultrasounds, and certain cardiology tests will no longer require a prior authorization for some of the  following plan types: 1.UnitedHealthcare Insurance Company2.UnitedHealthcare Mid-Atlantic, inc. 3.UnitedHealthcare Plan of the River Valley, Inc. and 4.UnitedHealthcare Insurance Company of the River Valley5.Oxford Health Insurance, Inc.United Healthcare Level Funded (formerly All…

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Anthem BCBS NY: New PET tracer UM policy

The following information will apply to any DOS on 12/1/25 and thereafter. Starting 12/1/25 the PET tracer will require an auth in addition to PET services. Please submit both PET and radiotracer codes- for prior authorization. The UM criteria for PET will not be affected. However both codes will be either approved or denied. Please…

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PrEP proper billing and coding

Proper Medical coding and billing is important to the financial health of your practice! Medication codes: Administration code Please avoid using the regular 96372 administration code. Instead use the following administration code: G0012 This code is used when the provider physically administers the PrEP medication. Supply Code For the oral PrEP pharmacies should bill: Q0251…

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Posted in #aetna, Training, Updates

Aetna Better Health of Florida to pay for certain Z codes

Posted on by KR2Medical Billing

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

Partial list of covered Z codes:

For full list of the covered Z codes that are covered, please click here.

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MVP to end its relationship with naviHealth, Inc

Currently naviHealth, Inc handles Utilization and Case/Care Management for post-acute services—including Skilled Nursing Facility (SNF), Inpatient Rehabilitation Facility (IRF), and Home Health—for MVP Medicare Advantage, DualAccess, and DualAccess Complete Members. However, MVP and naviHealth, Inc will end their contract as of Dec 31st 2025. Starting on Jan 1,2025 MVP will process these requests in house.…

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MVP postpartum program incentive payments: NY providers!

Are you any of these following providers in NY? OB/GYN Family Medicine Certified Nurse Mid-wives Nurse Practitioner – Family Health Then this blog post is for you! NY DOH established an additional payment (to global OBGYN bundled payment) for providers that complete a person-centered postpartum visit— including a depression screening—within 12 weeks of delivery, as…

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BcBS HighMark NY: coverage for COVID-19 vaccine

According to Highmark BCBS- the COVID-19 vaccine will be covered with out any pocket costs through 2025-2026. This currently only applies to Managed Medicaid, Child Health Plus, Essential and HARP plan types. The vaccine will still be part of standard preventive care benefits, COVID‑19 vaccines are covered for all members older than 6 months of…

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Posted in #aetna, #Medicare, #Medicareadvantage, Training, Updates

Aetna Medicare Advantage: participating providers’ post-service appeals new address

Posted on by KR2Medical Billing

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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