Tag: #EmblemGHI

Posted in In The Know Series, Insurance, Training

Emblem GHI PPO (commercial members)-new member IDs for 2020

Posted on by KR2Medical Billing

Starting, in the beginning of 2020, Emblem GHI PPO commercial members will receive new ID numbers and new ID cards.

The following changes will take place:

  1. New ID numbers will start with a letter K
  2. New ID numbers will have only 8 number spaces
  3. The last 2 digit numbers will reflect the # for each dependent (eg. 01, 02, 03)
  4. Will be subject to the radiation therapy and cardiology imaging (eviCore) programs
  5. Will be subject to HIP radiology and self referral payment policy.

GHI PPO (City of New York members) are not affected by this change.

 Medicare PPO Members who are on Medicare Choice PPO network will have the new ID change but will not be subject to eviCore Programs.

The process is expected to continue through the end of 2020.

Posted in In The Know Series, Insurance, My services, Payers and CPT reinbursement

Does more GHI patients = more revenue? Year 2018

Posted on by KR2Medical Billing

In recent 2 months or so, I have seen an influx of GHI patients coming to my practice.

Great for business, right?….Well it depends on your preference and financial stability of your practice.

Let me Explain.

In the last year In Network Providers have noticed an increase in “Patient Financial Responsibility” and substantial reductions in payments for certain allergy and immunology CPT codes and/or EM codes.

For Example: CPT code like 99213 carries a $30 co-pay and payment of $17 to the provider or no co-pay and a payment of $40 or co-pay of $10 and a payment of $37 to the provider, or co-pay of $30 and a payment of $24 to the provider.

CPT code 94200- carries a $20 co-pay with no payment at all and a co-pay of $22 for CPT code 95117 with no additional payment.

Respectively lower payments compare to other payers.

Providers started to notice this trend and slowly but surely some of them started to either stop accepting new GHI patients or completely stop accepting GHI insurance all together, like ENT.

So should you accept more GHI patients? Well, it is up to you.

I personally created a specific form for GHI patients- informing them of new changes and their new Patient Financial Responsibilities. I let the patients have options to either choose to perform certain services and pay respective co-pay or opt out completely.

Now it is your turn: have you seen an increased amount of GHI patients in your practice? Do you even accept GHI?