Posted in #aetna, Training, Updates

Aetna: Non participating provider New Timely filling frame

Recently, while I was preparing for my Denials Management Made Easy Webinar (Physician Services), coming soon, I researched the 8 most common denial types.

One of those common denials is timely filing.

Picture via Performance Adjusting

Timely filling frame is the time given to providers to send their clean claims to the insurance payer. Each insurance payer has different timely filling time frames. These time frames also differ for In and Out of network providers.

Training your staff on keeping current with timely filling changes will help you avoid unnecessary denials and ensure that claims are submitted on time and paid.


In this article, as you see by the title of it, we will look at the timely filling requirements change for AETNA Out of network providers.

As per Aetna, for all claims submitted on or after DOS 01/01/2022 the new timely filling will be 12 months. Down from 27 months.

Aetna is doing this to match Centers for Medicare & Medicaid Services (CMS) standards. The change will apply to medical procedures.

Dental Out of network providers will continue to have 27 months timely filling frame for their claims.


According to Aetna the denials will start showing up in 2023 and all policy exceptions to timely filing today will apply after this change and will be supported as they are today.


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Posted in #Medicareadvantage, #unitedhealthcare, Training, Updates

UHC Commercial and Exchange Plans: update to Radiology Prior Auth List

As of December 1,2021 the following codes will be added to the radiology prior authorization list. These codes will require an authorization for DOS 12/01/2021 and thereafter.

The prior authorization for these codes WILL NOT APPLY TO The following situations: if the advanced imaging is done in-

  • Emergency room
  • Urgent care center
  • Observation unit
  • Inpatient stay

In case you missed it:

In June 2021, UHC also added more Radiology and Cardiology codes on the Prior Authorization List. These codes apply to UnitedHealthCare Community Plan, Medicare Advantage, commercial and exchange Plans


For complete details on the radiology protocol, refer to the current UnitedHealthcare Administrative Guide


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Posted in #Medicareadvantage, #unitedhealthcare, Training, Updates

Dialysis Billing Update: UHC Medicare Advantage

If you have patients with UHC Medicare Advantage Plan? Then this blog post is for you.

Starting October 1st 2021 UHC Medicare Advantage Plan updated their billing information in order to avoid Denials.

Modifiers: UHC Medicare Advantage Plan requests that providers bill the dialysis treatment with the following modifiers: CG or KX for dialysis treatment

Revenue Codes: 821 and 881

CPT code: 90999

Coverage: Dialysis treatments that exceed 14 treatments in a calendar month will be reviewed per CMS Frequency of Hemodialysis (A55703) LCD

If you would like to read the whole CMS Frequency of Hemodialysis (A55703) LCD please click here.


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