Tag: #claims

Posted in NY Providers, Payer Updates, Updates

EmblemHealth updated timely filling date (claims) for self funded plans!

Posted on by KR2Medical Billing

According to EmblemHealth-for self funded plans: Local 389 Health and Welfare fund- for the DOS 9/1/23 and thereafter have a new timely filling date for submitting claims. The new date is 90 days after the services were rendered.

This new time frame applies to In network and Out of Network providers.

Types of claims: professional, facility and other provider types

Please note that this change DOES NOT APPLY to the other ASOs (Administrative Service Organizations).

The following is still in affect:

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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 Insurance

Announcement: NY Empire Plan Claim Submission for 2019 Services -April 29,2020

Posted on by KR2Medical Billing

General: Please remember that UnitedHealthCare (claim administrator for NY Empire Plan) has a claim submission policy  of 120 days from the DOS (Date of Service). Empire Plan Secondary Claims also have a claim submission policy of 120 days from the date that Medicare or another insurance claim has processed the claim.

For Services performed  at the end of year 2019 have to be submitted on April 29,2020

Paper Claims Address: those providers that are unable to submit electronic claims have to send their claims to The Empire Plan, PO Box 1600, Kingston, NY 12402-1600

Reminder: When benefits are denied because of the claim being submitted late, the participating physician or health care professional MAY NOT BILL the patient for the charges on that claim.

Posted in In The Know Series, Insurance, Training, Updates

NY State Empire Plan-Announcement-claim submission time frames deadline-2020

Posted on by KR2Medical Billing

*Please do not forget that UnitedHealthCare is the administrator for this plan and processes the claims for its members.*

Therefore the providers need to adhere to the following timely claim filing frames:

+No later than 120 days from the end of the calendar year in which the services were rendered (initial claim submission)

OR

+Within 120 days after Medicare or another insurance plan process the claim (secondary claims), whichever is later.

+Empire Claims (for 2019 services) need to be submitted to UHC for processing by April 29,2020

IMPORTANT!

If the claim is denied due to late submission, the participating provider or health care professional may NOT bill the patient for the charges on that claim!