Posted in Insurance, Updates

EmblemHealth GHI PPO-NYC members-member ID change

Starting 07/01/2020, the claims for Emblem GHI PPO (NYC members) will be processed on another claims platform. In order to comply with this change the member ID’s will be changed to the format of K + 10 (numbers).

The Empire cards ( for hospital benefits) will also reflect this change- however they will display only 9 digits. Please see below:

Other notable changes:

+ Beacon Health Options will start to process Behavioral Health claims. Beacon Health Options information will be now included on the back of the EmblemHealth Cards.

+ In-office lab rules will apply to all EmblemHealth members, including GHI PPO (NYC members).

Posted in Insurance, Training

Telemedicine/Telehealth Benefit Updates: Aetna, UHC, EmblemHealth, Cigna

Temporary Telehealth Policy Updates:

Updated on 06/01/2020-AETNA

1. Aetna will waive member cost sharing for any Diagnosis related telemedicine visit- Commercial Type Plans

2. For outpatient behavioral and mental health counseling services-Aetna is waiving cost sharing for Commercial  Type Plans.

3. For telephone ONLY services- Aetna will cover Commercial Type Plans until 08/04/2020- but the cost sharing waiver will end on June 4/2020. Included services are:  …”minor acute care evaluation and care management services, as well as some behavioral health services…”

Updated 05/31/2020-UHC

1. For non-COVID 19 related telemedicine,Virtual Check-Ins Electronic Visits (e-visits),Physical Therapy (PT), Occupational Therapy (OT),  Speech Therapy (ST),  Chiropractic Therapy Home Health and Hospice Remote Patient Monitoring-UHC will waive member cost sharing until 06/18/2020-for Individually Insured, Fully Insured and Group Market Health Plans.

2. Telehealth Expansion- ONLY applies towards the plans that already have the telehealth benefit.

   -Medicare Advantage-Expanded through Sept 30,2020

   -Individually Insured, Fully Insured and Group Market Health Plans-expanded through July 24,2020

Updated on 05/12/2020-EmblemHealth

1. There is no end date for telehealth services- Emblem only stated the following:

 This change in policy is effective until the end of the COVID-19 public health emergency or sooner as permitted by law and will be communicated through all appropriate channels”.

2. EmblemHealth is waving member cost sharing for all plan types

3. No telehealth modifier needed for 98966-98968 and 99441-99443

Updated on 06/1/2020-Cigna

1.Cigna will extend their member cost sharing waiver until 07/31/2020. However this policy applies to members with Individual and Family Plans (IFP). Additionally, for IFP and Medicare Advantage customers only. Services include non COVID-19 primary, specialty, and behavioral health care.

2. Other Commercial Plans- member cost sharing is NOT waived.

3. Services have to performed ONLY by INN providers

https://static.cigna.com/assets/chcp/resourceLibrary/medicalResourcesList/medicalDoingBusinessWithCigna/medicalDbwcCOVID-19.html