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…
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…
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…
KR2 Medical Billing 