Tag: #Managedmedicaid

Posted in MVP (NY/VT) Insurance Payer, NY Providers, Training, Updates

MVP (NY): ABA Services Coverage update DOS 10/01/21 and thereafter

Posted on by KR2Medical Billing

This blog post applies to physicians that are providing ABA ( Applied Behavior Analysis) services to MVP Managed Medicaid Patients.

Earlier this year MVP sent a notice to patients and Physicians that ABA (Applied Behavior Analysis) services will be covered for patients under 21 years old that have the MVP Managed Medicaid Plan, effective 10/01/2021

However, NY DOH (NY Department of Health) changed that for DOS 10/01/2021 and thereafter.

As of now ABA services are NOT COVERED FOR MVP Managed Medicaid Plans (for patients 21 years old and younger).

NY DOH will continue to cover the ABA Services for only Medicaid fee-for-service members, 21 years old and younger.

MVP is monitoring NY DOH and will make timely updates available as applicable.

Find this type of content helpful? Follow my blog for more medical/reimbursement policy updates, medical billing and coding guideline changes, and any other healthcare field related news!

Recent Blog Posts:

Posted in Insurance, Training, Updates

MVP (NY/VT) & Reimbursement Policy for 95165 (Allergen Serum Preparation), 01/01/2021

Posted on by KR2Medical Billing

According the MVP Provider Manual, effective 01/01/2021 MVP (Vermont and NY) will only reimburse for the following units (specify quantity):

First Year:

Max # of units per claim/DOS is 40

Max # of units per calendar year is 150

Subsequent Years:

Max # of units per claims/DOS is 30

Max# of units per calendar year is 30

This is a BIG CHANGE from the previous reimbursement quantities. As recent as July 1,2020- MVP used to reimburse for 150 units for the first year and 120 units for the subsequent years.

Please see below: JULY 01/2020 version

January 1/2021 version:

#allergenimmunothearpy #allergist #allergy #allergy serum #asthma

Most Recent Posts:

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…

KR2Medical Billing's avatar by KR2Medical Billing

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…

KR2Medical Billing's avatar by KR2Medical Billing

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…

KR2Medical Billing's avatar by KR2Medical Billing
Posted in Insurance, Updates

New York Providers: Empire non-covered services for Managed Medicaid Care

Posted on by KR2Medical Billing

NOTE: This announcement was published in Empire NY Providers communication section on FEB 1,2020

According to Empire BCBS Health Plus (NY)- starting back in 12/1/2019- they began denying claims that were billed with non-covered codes (NY Medicaid).

HCPCS and CPT codes that are not on the NY Medicaid fee schedule are considered non-covered.

This policy affects only MMC and Child Health Plus programs.

Empire suggests that some of these non covered codes should be billed with a more appropriate code or a code that is considered (bundled).

For the list of COVERED codes please click on https://www.emedny.org.

For a complete list of NON covered CPT/HCPCS codes please visit: https://mediproviders.empireblue.com/ProviderUpdates/NYNY_CAID_PU_NoncoveredCPTHCPCSCodes.pdf

Providers should bill the most current CPT or HCPCS code on the current NY Fee Schedule to avoid unnecessary denials.

If you have questions about this announcement please contact your Provider Relations Representative or the Provider Services: 1-800-450-8753